Work

Immune Checkpoint Inhibitors in Cancer Patients With Concurrent Active Tuberculosis: A Real-World Study in a High Tuberculosis Burden Region

Year: 2026

Type: article

Abstract: Background This study aimed to assess the incidence and clinical characteristics of active tuberculosis (ATB) in cancer patients treated with immune checkpoint inhibitors (ICIs) to inform optimal ICI utilization strategies in TB-endemic areas. Methods We conducted a retrospective analysis of 889 consecutive cancer patients who received at least one cycle of ICIs at The Third People's Hospital of Shenzhen between 01/01/2018 and 31/12/2024. Patients who developed ATB following ICI initiation were identified, and their demographic data, tumor type, ICI regimen, medical history, body mass index (BMI), and TB characteristics (time of occurrence, site) were systematically evaluated. Results Among 889 patients, the median follow-up duration was 19 months (IQR 9.7–32 months). The total follow-up time for the entire cohort was 1634.1 person-years. Forty-four patients developed ATB. The TB incidence rate was 2693 per 100 000 person-years (95% CI: 1956–3607). A total of 169 patients died during follow-up and 20 were lost to follow-up; data for both groups were censored at the last known contact date. All affected patients were male, with a median age of 61 years and a median BMI of 18.1 kg/m2. Lung cancer is an independent risk factor for ATB associated with ICIs. The median time to ATB onset after ICI initiation was 7.1 months, and patients had received a median of 5 ICI treatment cycles prior to TB diagnosis. Conclusions This single-center retrospective cohort from a high TB-burden region demonstrated an observed TB incidence of 2693 cases per 100 000 person-years, which is higher than the general population incidence in China (55 per 100 000). While this observation cannot establish a causal relationship between ICIs and TB, it suggests that TB screening and monitoring protocols may warrant consideration in similar clinical settings. Prospective controlled studies are needed to confirm the attributable TB risk associated with ICI therapy.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofag517

Authors: Xunqi Liu, Yuan Cai, Ling Shao, Hu Liu, Jianghong An

Institutions: Southern University of Science and Technology, Shenzhen Third People’s Hospital

Language: English

Topic: Tuberculosis Research and Epidemiology

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,053