Abstract
Nivolumab (PD-1 inhibitor) and other immune checkpoint inhibitors are used primarily to promote reactivation of anti-tumor immunity. However, due to their generalized immunorestorative properties, these agents may also trigger an unusual spectrum of side-effects termed immune-related adverse events. In the case of the lung, pulmonary infiltrates in patients treated with the anti-PD-1 inhibitors, nivolumab, or pembrolizumab, especially patients with non-small cell lung cancer, can result from immune-related pneumonitis, which, until fairly recently was believed to be of non-infective origin. This, in turn, may result in progression and pseudo-progression of disease. An increasing body of evidence has, however, identified pulmonary tuberculosis as an additional type of anti-PD-1 therapy-associated, immune-related adverse event, seemingly as a consequence of excessive reactivation of immune responsiveness to latent Mycobacterium tuberculosis infection. The current case report describes a 56-year old Caucasian female who presented with microbiologically-confirmed tuberculosis infection while on nivolumab therapy for non-small cell lung cancer. Notably, the patient, seemingly the first described from the African Continent, had not received immunosuppressive therapy prior to the diagnosis of tuberculosis.
Highlights
The focus of this case report, has been shown to have a significant overall survival benefit compared to docetaxel in the setting of second-line treatment of non-small cell lung cancer (NSCLC)
Pneumonitis is more commonly seen with PD-1 and PD-L1 inhibitors than with CTLA-4 inhibitors [4]
The current case report represents a meaningful addition to the current literature on the association of anti-PD-1 based monoclonal antibody therapy of advanced cancer with subsequent development of acute pulmonary tuberculosis (PTB), as it may be the first description of this type of immune-related adverse events (IrAEs) originating from subSaharan Africa, a region with a high prevalence of TB
Summary
The focus of this case report, has been shown to have a significant overall survival benefit compared to docetaxel in the setting of second-line treatment of non-small cell lung cancer (NSCLC). All of these reports, which are summarized, involve administration of the PD-1-targeted monoclonal antibodies nivolumab (7 patients) or pembrolizumab (4 patients) to patients suffering from lung cancer (n = 5), malignancies of the upper respiratory tract (n = 2), advanced melanoma (n = 2), Hodgkin’s lymphoma (n = 1) and Merkel cell carcinoma (n = 1) [7,8,9,10,11,12,13,14,15].
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