Abstract
BackgroundIn our previous study, colorectal cancer (CRC) patients with active Mycobacterium tuberculosis (MTB) tolerated concurrent anti-cancer chemotherapy (anti-CCT) and anti-MTB chemotherapy. In this study, we retrospectively confirmed the efficacy and safety of concurrent chemotherapy in a greater number of patients with different types of malignancies.MethodsWe enrolled 30 patients who were treated concurrently with anti-CCT and anti-MTB regimens between January 2006 and February 2016. Cancer and MTB treatments were administered according to the approved guidelines.ResultsPatient demographics included: men/woman: 24/6; median age: 66.5 years; Eastern Cooperative Oncology Group performance status 0–1/2/3–4: 24/4/2; Stage IIB–IIIC/IV/recurrence: 6/22/2; lung cancer (LC)/CRC/other: 15/10/5; and MTB diagnosis (before or during anti-CCT): 20/10 (LC: 8/7; CRC: 8/2; other: 4/1). For anti-CCT, 23 patients received two cytotoxic agents with or without targeted agents and 7 patients received a single cytotoxic or targeted agent. The overall response rate was 36.7%. Regarding anti-MTB chemotherapy, 22 patients received a daily drug combination containing isoniazid, rifampicin, and ethambutol, plus pyrazinamide in 15 of the 22 patients, followed by daily isoniazid and rifampicin; the remaining 8 patients received other combinations. Hematological adverse events of Grade ≥ 3 were observed in 19 (67.9%) of 28 patients; laboratory data were lost for the remaining 2. Grade 3 lymphopenia and higher were significantly more frequent in LC compared to other malignancies (P < 0.005). Non-hematological adverse events of Grade ≥ 3 were observed in 5 (16.7%) of 30 patients. One CRC patient experienced Grade 3 hemoptysis and another 2 experienced Grade 3 anaphylaxis. One patient with cholangiocellular carcinoma and gastric cancer experienced Grade 3 pseudomembranous colitis as a result of a Clostridium difficile infection. One patient (3.3%) died of pemetrexed-induced pneumonitis. The success of the anti-MTB chemotherapy was 70.0%. There were no MTB-related treatment failures. The median overall survival (months, 95.0% confidence interval) was 10.5 (8.7–36.7), 8.7 (4.7–10.0), 36.7 (minimum 2.2), and 14.4 (minimum 9.6) for all patients combined, LC, CRC, and Other malignancies, respectively. LC patients experienced delayed MTB diagnosis and shorter overall survival.ConclusionsConcurrent chemotherapy is effective and safe for treating cancer patients with active MTB.
Highlights
In our previous study, colorectal cancer (CRC) patients with active Mycobacterium tuberculosis (MTB) tolerated concurrent anti-cancer chemotherapy and anti-MTB chemotherapy
We retrospectively examined the clinical course and chemotherapy outcomes of a larger number of patients treated concurrently with anti-Cancer chemotherapy (CCT) and anti-MTB chemotherapy
Fifteen patients were diagnosed with lung cancer (LC), 10 patients were diagnosed with CRC, and 5 patients were diagnosed with other malignancies (GC [n = 1], Breast Cancer [n = 1], LC with gastric cancer (GC) [n = 1], CRC with GC [n = 1], and CCA with GC [n = 1])
Summary
Colorectal cancer (CRC) patients with active Mycobacterium tuberculosis (MTB) tolerated concurrent anti-cancer chemotherapy (anti-CCT) and anti-MTB chemotherapy. We retrospectively confirmed the efficacy and safety of concurrent chemotherapy in a greater number of patients with different types of malignancies. Active MTB infections may be present in cancer patients, our previous preliminarily report [2] is the only study to discuss the clinical course and chemotherapy outcomes of concurrent anti-cancer chemotherapy (anti-CCT) and anti-MTB chemotherapy, revealing that patients with metastatic colorectal cancer (CRC) and active MTB could safely and effectively continue anti-CCT, and achieve comparable survival to those without the infection, upon receiving appropriate MTB treatment [2]. We retrospectively examined the clinical course and chemotherapy outcomes of a larger number of patients treated concurrently with anti-CCT and anti-MTB chemotherapy
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