Abstract:

Objective: To study the relation of tuberculosis and inhibitors of programmed death protein-1 and its ligand (PD-1/PD-L1), to improve the understanding of development of active tuberculosis in tumor patients treated with PD-1/PD-L1 antibody. Methods: The clinical characteristics and treatment outcomes of 5 patients who developed active tuberculosis when using PD-1/PD-L1 inhibitors for their malignant tumor from February 2017 to October 2022 were retrospectively analyzed. Literature associated tuberculosis related to PD-1/PD-L1 inhibitors from 2016 January 1st to 2022 June 25th included in PubMed, Cochrane Library and CNKI was reviewed. Reported clinical features of active tuberculosis in patients with PD-1/PD-L1 inhibitors therapy were summarized. Results: Among 5 patients, 4 were male and 1 was female. None of them had been screened for tuberculosis before the use of PD-1/PD-L1 inhibitors. Active pulmonary tuberculosis developed at 3rd to 12th months after administration of PD-1/PD-L1 inhibitors. All patients were diagnosed with active pulmonary tuberculosis by etiological examination. After anti-tuberculosis treatment, 2 patients got improved, 2 patient was cured and 1 patient died; 2 patients restarted using PD-1/PD-L1 inhibitors. Among 14 patients reported in 12 literature, the median time of tuberculosis onset was the 5th month after administration of PD-1/PD-L1 inhibitors. Eleven patients were active pulmonary tuberculosis and 3 were extrapulmonary tuberculosis; 10 patients got improved after anti-tuberculosis treatment, 2 patients died and 2 with unknown outcomes. There were 7 patients restarted PD-1/PD-L1 inhibitors therapy. Conclusion: It is necessary to be alert to the occurrence of active tuberculosis during the treatment of PD-1/PD-L1 inhibitors. It is relatively safe to restart PD-1/PD-L1 inhibitors therapy after tuberculosis is controlled.

Key words: Tuberculosis, pulmonary, PD-1/PD-L1 antibody, Review literature as topic