Assessment of anti-PD-(L)1 for patients with coexisting malignant tumor and tuberculosis classified by active, latent, and obsolete stage.
Assessment of anti-PD-(L)1 for patients with coexisting malignant tumor and tuberculosis classified by active, latent, and obsolete stage.
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DOI：
10.1186/s12916-021-02194-z
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发表时间：
2021-12-20
期刊：
影响因子：
9.3
通讯作者：
Dong ZY
中科院分区：
文献类型：
--
作者：
Su S;Ye MF;Cai XT;Bai X;Huang ZH;Ma SC;Zou JJ;Wen YX;Wu LJ;Guo XJ;Zhang XL;Cen WC;Su DH;Huang HY;Dong ZY
患者同时患有恶性肿瘤和肺结核并不少见。对这些患者，特别是活动性肺结核合并抗结核治疗的患者，应用程序性死亡配体1[PD-(L)1]抑制剂是否可行，目前尚不清楚。本研究纳入2018年1月至2021年7月在2个机构接受抗PD-(L)1治疗的恶性肿瘤和结核病并存的患者。观察两组患者的无进展生存期、客观缓解率、抗PD-(L)1治疗的安全性和抗结核治疗的反应。这项队列研究共筛选出98名患者，其中45名(45.9%)、21名(21.4%)和32名(32.7%)分别被诊断为活动性、潜伏性和陈旧性肺结核。抗PD-(L)1治疗的总有效率为36.0%，各亚组分别为34.2%、35.5%和41.2%。在本分析时，每个亚组的中位PFS分别为8.0月、6.0月和6.0月(P=0.685)。同时接受抗结核治疗的活动性肺结核患者的中位抗结核治疗时间为10.0(95%CI，8.01~11.99)个月。抗结核治疗后，83.3%(20/24)患者痰转阴，93.3%(42/45)患者显影有效，2例复发。值得注意的是，在抗PD-(L)1治疗后，潜伏期患者和陈旧亚组中只有一名患者表现出结核病诱导或复发。在同时使用抗PD-(L)1和抗结核药物时，33例(73.3%)患者发生了与治疗相关的不良事件(TRAE)。3级及以上TRAE为血液毒性(5例，11.1%)，1例发生3级肺炎，停用免疫治疗。本研究表明，恶性肿瘤和肺结核并存患者从抗PD-(L)1治疗中获益均等，而活动性肺结核患者的抗结核反应不受影响。值得注意的是，抗PD-(L)1和抗结核病治疗的组合耐受性良好，没有显著的意想不到的毒性反应。网上版载有补充材料，可在10.1186/s12916-021-02194-z查阅。
It is not a rare clinical scenario to have patients presenting with coexisting malignant tumor and tuberculosis. Whether it is feasible to conduct programmed death-(ligand) 1 [PD-(L)1] inhibitors to these patients, especially those with active tuberculosis treated with concurrent anti-tuberculosis, is still unknown. This study enrolled patients with coexisting malignancy and tuberculosis and treated with anti-PD-(L)1 from Jan 2018 to July 2021 in 2 institutions. The progression-free survival (PFS), objective response rate (ORR), and safety of anti-PD-(L)1 therapy, as well as response to anti-tuberculosis treatment, were evaluated. A total of 98 patients were screened from this cohort study, with 45 (45.9%), 21 (21.4%), and 32 (32.7%) patients diagnosed with active, latent, and obsolete tuberculosis, respectively. The overall ORR was 36.0% for anti-PD-(L)1 therapy, with 34.2%, 35.5%, and 41.2% for each subgroup. Median PFS was 8.0 vs 6.0 vs 6.0 months (P=0.685) for each subgroup at the time of this analysis. For patients with active tuberculosis treated with concurrent anti-tuberculosis, median duration of anti-tuberculosis therapy was 10.0 (95% CI, 8.01–11.99) months. There were 83.3% (20/24) and 93.3% (42/45) patients showing sputum conversion and radiographic response, respectively, after anti-tuberculosis therapy, and two patients experienced tuberculosis relapse. Notably, none of the patients in latent and only one patient in obsolete subgroups showed tuberculosis induction or relapse after anti-PD-(L)1 therapy. Treatment-related adverse events (TRAEs) occurred in 33 patients (73.3%) when treated with concurrent anti-PD-(L)1 and anti-tuberculosis. Grade 3 or higher TRAEs were hematotoxicity (n = 5, 11.1%), and one patient suffered grade 3 pneumonitis leading to the discontinuation of immunotherapy. This study demonstrated that patients with coexisting malignant tumor and tuberculosis benefited equally from anti-PD-(L)1 therapy, and anti-tuberculosis response was unimpaired for those with active tuberculosis. Notably, the combination of anti-PD-(L)1 and anti-tuberculosis therapy was well-tolerated without significant unexpected toxic effects. The online version contains supplementary material available at 10.1186/s12916-021-02194-z.
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影响因子：
8.4
作者：
Eisenhauer, E. A.;Therasse, P.;Verweij, J.
通讯作者：
Verweij, J.
影响因子：
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作者：
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作者：
Fujita, Kohei;Terashima, Tsuyoshi;Mio, Tadashi
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DOI：
10.1056/nejmoa1504627
发表时间：
2015-07-09
期刊：
The New England journal of medicine
影响因子：
--
作者：
Brahmer J;Reckamp KL;Baas P;Crinò L;Eberhardt WE;Poddubskaya E;Antonia S;Pluzanski A;Vokes EE;Holgado E;Waterhouse D;Ready N;Gainor J;Arén Frontera O;Havel L;Steins M;Garassino MC;Aerts JG;Domine M;Paz-Ares L;Reck M;Baudelet C;Harbison CT;Lestini B;Spigel DR
通讯作者：
Spigel DR