ICIs linked to higher risk of TB reactivation, infection in cancer patients

Routine TB screening before immune checkpoint inhibitor treatment may be beneficial for cancer patients, researchers say

Immune checkpoint inhibitor (ICI) treatment may increase the risk of tuberculosis reactivation or latent tuberculosis infection in patients with cancer, according to research published in The Oncologist.

Researchers conducted retrospective and prospective studies and found that ICI treatment is associated with a higher likelihood of tuberculosis reactivation and latent tuberculosis infection, when compared to treatment with tyrosine kinase inhibitors (TKIs), in patients with lung cancer, head and neck cancers, and other cancers.

Retrospective Study

The retrospective study included data from 2049 patients with lung cancer who were treated with ICIs (n=442) or TKIs (n=1607).

Tuberculosis was reported in 1.58% of patients treated with ICIs and 0.68% of those treated with TKIs (P =.0728). The incidence rate of tuberculosis was 2245 per 100,000 person-years in the ICI group and 630 per 100,000 person-years in the TKI group (P =.0138).

In a propensity score-matched cohort, tuberculosis was observed in 1.62% of ICI recipients and 0.46% of TKI recipients (P =.0938). The incidence rate of tuberculosis was 2298 per 100,000 person-years in the ICI group and 412 per 100,000 person-years in the TKI group (P =.0165).

ICI use was independently associated with tuberculosis in a multivariate analysis (adjusted hazard ratio [aHR], 6.29; 95% CI, 1.23-32.09; P =.0269).

Prospective Study

To confirm the findings from the retrospective study, the researchers evaluated a prospective cohort of 122 patients with lung cancer, head and neck cancer, and other cancers. The patients were treated with ICIs (n=72) or TKIs (n=50).

At baseline, the rate of latent tuberculosis infection was 20% in the TKI group and 15.1% in the ICI group (P >.05).

During follow-up, however, the rate of new latent tuberculosis infection was 18% in patients treated with ICIs and 0% in those treated with TKIs (P =.036).

A multivariate analysis showed that ICI use was an independent risk factor for latent tuberculosis infection (aHR, 9.88; 95% CI, 1.13-1297.16; P =.035). Another independent risk factor was older age (aHR per 1-year increment, 1.07; 95% CI, 1.00-1.16; P =.039).

“The use of ICIs may be linked to a higher likelihood of TB [tuberculosis] reactivation and LTBI [latent tuberculosis infection] than individuals solely receiving TKIs as anticancer therapy,” the researchers concluded. “Consequently, the implementation of a screening program for TB reactivation and LTBI among patients undergoing ICI treatment could prove advantageous by enabling early detection and prompt treatment of the infection.”