Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Cancer Immunol Immunother. 2021 Nov;70(11):3105-3111. doi: 10.1007/s00262-021-02905-8. Epub 2021 Mar 26.
Immune checkpoint inhibitors (ICIs) blocking inhibitory immune pathways (e.g., programmed cell death protein-1/-ligand1 [PD-1/PD-L1]) have revolutionized cancer therapy for numerous malignancies. There have been an increasing number of cases of active tuberculosis (TB) reported in association with ICI use, and recent data suggest alterations in immune responses in TB by ICI. The aim of this study was to characterize the frequency of latent tuberculosis infection (LTBI) and active TB in a large cohort of ICI-treated patients in a low TB incidence area.
We conducted a retrospective review of all ICI-treated patients tested for TB between January, 1997 and August, 2018. Data extracted included patient demographics, TB risk factors, latent/active TB diagnosis and treatment, tumor type, ICI used, immunosuppressive medications, and mortality related to TB.
We identified 1844 ICI-treated patients, including 30 abnormal TB test results. Two patients were diagnosed with active TB, both prior to starting ICI therapy. One patient was treated for TB prior to starting ICI and the other patient was successfully treated concurrently. Seven patients were diagnosed with LTBI and none developed active TB. Twenty patients had indeterminate interferon gamma release assays (IGRA).
Despite recent reports of TB in patients taking ICI, we found no patients developing TB during ICI therapy in our large retrospective cohort of ICI-treated cancer patients in a non-endemic TB area. The high rate of indeterminate IGRA results suggests the need for prospective research with better diagnostics to quantify the actual risk of TB in this patient population.
免疫检查点抑制剂（ICIs）阻断抑制性免疫途径（例如，程序性细胞死亡蛋白-1/-配体 1 [PD-1/PD-L1]）已经彻底改变了许多恶性肿瘤的癌症治疗方法。在使用 ICI 的情况下，越来越多的活动性结核病（TB）病例被报道，并且最近的数据表明 ICI 改变了 TB 中的免疫反应。本研究的目的是在低 TB 发生率地区的大量 ICI 治疗患者中，描述潜伏性结核感染（LTBI）和活动性 TB 的频率。
我们对 1997 年 1 月至 2018 年 8 月期间接受 ICI 治疗且接受过 TB 检测的所有 ICI 治疗患者进行了回顾性分析。提取的数据包括患者的人口统计学、TB 危险因素、潜伏性/活动性 TB 诊断和治疗、肿瘤类型、使用的 ICI、免疫抑制药物以及与 TB 相关的死亡率。
我们确定了 1844 名接受 ICI 治疗的患者，其中有 30 例 TB 检测结果异常。有 2 名患者被诊断为活动性 TB，均在开始 ICI 治疗之前。1 名患者在开始 ICI 治疗之前接受了 TB 治疗，另 1 名患者同时成功治疗。有 7 名患者被诊断为 LTBI，均未发展为活动性 TB。有 20 名患者的干扰素γ释放试验（IGRA）结果不确定。
尽管最近有报道称使用 ICI 的患者出现了 TB，但在非流行 TB 地区的接受 ICI 治疗的大量癌症患者的回顾性队列中，我们没有发现患者在 ICI 治疗期间发生 TB。IGRA 结果不确定的比例较高，表明需要进行前瞻性研究，采用更好的诊断方法来量化该患者人群中 TB 的实际风险。
