Tuberculosis following programmed cell death receptor-1 (PD-1) inhibitor in a patient with non-small cell lung cancer. C
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ORIGINAL ARTICLE
Tuberculosis following programmed cell death receptor‑1 (PD‑1) inhibitor in a patient with non‑small cell lung cancer. Case report and literature review Aasir M. Suliman1 · Shaza A. Bek2 · Mohamed S. Elkhatim2 · Ahmed A. Husain3 · Ahmad Y. Mismar1 · M. Z. Sharaf Eldean4 · Zsolt Lengyel5 · Shereen Elazzazy6 · Kakil I. Rasul2 · Nabil E. Omar6 Received: 12 May 2020 / Accepted: 11 September 2020 © The Author(s) 2020
Abstract Immune checkpoint inhibitors (ICIs)—anti-programmed death-1 (PD-1) and their ligands (PD-L1 and PD-L2) have become widely used in the treatment of several malignancies. Many immune-related adverse events (irAEs) have been linked to these agents. Nonetheless, tuberculosis (TB) reactivation during their use is increasingly recognized and reported. Herein, we present a 58-year-old lady with advanced non-small cell lung cancer (NSCLC) ALK-negative, EGFR wild, and PD-L1 immune histochemistry (IHC) strongly positive in 95% of tumor cells, on ongoing treatment with Pembrolizumab as a firstline monotherapy. Our patient presented with 1-week history of productive cough and high-grade fever. Further workup yielded the diagnosis of pulmonary tuberculosis after her Pembrolizumab sixth cycle with positive AFB smear and TB PCR from BAL (rifampin resistance not detected), with negative HIV status. Hence, immunotherapy was held, and patient was commenced on anti-TB regimen. History revealed contact with active TB patient over the past decade, without previous documentation of latent TB or previous TB infection. Her sputum AFB smear remained persistently positive 4 weeks through anti-TB regimen course. Later, the patient was discharged after her sputum was cleared from AFB (two negative sets). In light of pembrolizumab mechanism of action as an immune checkpoint inhibitor, we suspected its implication on reactivating latent TB which was observed in our patient demonstrating features of pulmonary tuberculosis. She was not re-challenged with Pembrolizumab following TB diagnosis. Keywords Tuberculosis · NSCLC · PD-1 inhibitor · Pembrolizumab · Immune related adverse events · Case report
Background
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00262-020-02726-1) contains supplementary material, which is available to authorized users. * Nabil E. Omar [email protected] 1
Department of internal medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
2
Department of Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
3
Department of Infectious Diseases, Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
Immune checkpoint inhibitors (ICIs) are a type of cancer immunotherapy that has provided a tremendous breakthrough in the field of oncology [1]. They inhibit inhibitory pathways of immune cells which allow more increased immune cell activity and reduce T-cell exhaustion [2]. 4
Department of Pathology, Hamad General Hospital, Hamad Medical Corporat
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