Journal Article

Assessment of anti-PD-(L)1 for patients with coexisting malignant tumor and tuberculosis classified by active, latent, and obsolete stage

Wu, Li-Juan, Huang, Hui-Yi, Su, Shan, Zhang, Xian-Lan, Dong, Zhong-Yi, Ma, Si-Cong, Wen, Yu-Xiang, Cen, Wen-Chang, Cai, Xiao-Ting, Zou, Jian-Jun, Su, Duo-Hua, Huang, Zhi-Hao, Guo, Xue-Jun, Ye, Mei-Feng, Bai, Xue

2021

Overview

Background It is not a rare clinical scenario to have patients presenting with coexisting malignant tumor and tuberculosis. Whether it is feasible to conduct programmed death-(ligand) 1 [PD-(L)1] inhibitors to these patients, especially those with active tuberculosis treated with concurrent anti-tuberculosis, is still unknown. Methods This study enrolled patients with coexisting malignancy and tuberculosis and treated with anti-PD-(L)1 from Jan 2018 to July 2021 in 2 institutions. The progression-free survival (PFS), objective response rate (ORR), and safety of anti-PD-(L)1 therapy, as well as response to anti-tuberculosis treatment, were evaluated. Results A total of 98 patients were screened from this cohort study, with 45 (45.9%), 21 (21.4%), and 32 (32.7%) patients diagnosed with active, latent, and obsolete tuberculosis, respectively. The overall ORR was 36.0% for anti-PD-(L)1 therapy, with 34.2%, 35.5%, and 41.2% for each subgroup. Median PFS was 8.0 vs 6.0 vs 6.0 months ( P =0.685) for each subgroup at the time of this analysis. For patients with active tuberculosis treated with concurrent anti-tuberculosis, median duration of anti-tuberculosis therapy was 10.0 (95% CI, 8.01–11.99) months. There were 83.3% (20/24) and 93.3% (42/45) patients showing sputum conversion and radiographic response, respectively, after anti-tuberculosis therapy, and two patients experienced tuberculosis relapse. Notably, none of the patients in latent and only one patient in obsolete subgroups showed tuberculosis induction or relapse after anti-PD-(L)1 therapy. Treatment-related adverse events (TRAEs) occurred in 33 patients (73.3%) when treated with concurrent anti-PD-(L)1 and anti-tuberculosis. Grade 3 or higher TRAEs were hematotoxicity ( n = 5, 11.1%), and one patient suffered grade 3 pneumonitis leading to the discontinuation of immunotherapy. Conclusions This study demonstrated that patients with coexisting malignant tumor and tuberculosis benefited equally from anti-PD-(L)1 therapy, and anti-tuberculosis response was unimpaired for those with active tuberculosis. Notably, the combination of anti-PD-(L)1 and anti-tuberculosis therapy was well-tolerated without significant unexpected toxic effects.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Apoptosis / Biomedicine / Cancer / Cancer therapies / Care and treatment / Chemotherapy / Cohort Studies / Confidence intervals / Diagnosis / Health aspects / Humans / Immunotherapy / Ligands (Biochemistry) / Lung cancer / Malignancy / Malignant tumor, Tuberculosis, PD1/PD-L1, Efficacy, Safety / Medicine / Medicine & Public Health / Neoplasms - complications / Neoplasms - drug therapy / Patient outcomes / Patients / Pneumonitis / Population / Research Article / Risk factors / Sputum / Subgroups / Therapy / Toxicity / Tuberculosis / Tuberculosis - complications / Tuberculosis - drug therapy / Tumors