Reativação de Tuberculose Pulmonar em uma Paciente com Câncer de Orofaringe Tratada com Nivolumabe: Relato de Caso
DOI:
https://doi.org/10.32635/2176-9745.RBC.2023v69n4.4477Palavras-chave:
inibidores de checkpoint imunológico, tuberculose pulmonar, tuberculose latenteResumo
Introdução: Os inibidores de checkpoints imunológicos (ICI) são uma classe de medicamentos cada vez mais utilizados para tratar o câncer. No entanto, eles têm sido associados a um risco aumentado de reativação da tuberculose (TB) em pacientes com infecção tuberculosa latente (ILTB). Relato do caso: Mulher, 61 anos, com câncer de orofaringe desenvolveu reativação de TB pulmonar enquanto recebia nivolumabe. Acredita-se que a reativação da TB em pacientes em ICI seja em virtude da inibição da via PD-1 que desempenha um papel no controle da ILTB. A incidência de reativação da TB em pacientes em ICI é maior do que na população geral. Conclusão: O uso crescente de ICI provavelmente levará a um aumento no número de casos de reativação da TB. Sugere-se proceder ao rastreamento rotineiro para ILTB nos pacientes que estão sendo considerados para tratamento com ICI, especialmente em países com alta incidência de TB.
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Kim Y, Lee J, Kim SJ, et al. Development of tuberculosis in cancer patients receiving immune checkpoint inhibitors. Respr Med. 2020;161:105853. doi: https://doi.org/10.1016/j.rmed.2019.105853 DOI: https://doi.org/10.1016/j.rmed.2019.105853
Fujita K, Kim YH, Kanai O, et al. Emerging concerns of infectious diseases in lung cancer patients receiving immune checkpoint inhibitor therapy. Respir Med. 2019;146:66-70. doi: https://doi.org/10.1016/j.rmed.2018.11.021 DOI: https://doi.org/10.1016/j.rmed.2018.11.021
Chan GH, Gwee YX, Low JL, et al. Immune checkpoint inhibition for non-small cell lung cancer in patients with pulmonary tuberculosis or hepatitis B: experience from a single Asian Centre. Lung Cancer. 2020;146:145-53. doi: https://doi.org/10.1016/j.lungcan.2020.05.020 DOI: https://doi.org/10.1016/j.lungcan.2020.05.020
Zaemes J, Kim C. Immune checkpoint inhibitor use and tuberculosis: a systematic review of the literature. Eur J Cancer. 2020;132:168-75. doi: https://doi.org/10.1016/j.ejca.2020.03.015 DOI: https://doi.org/10.1016/j.ejca.2020.03.015
Anastasopoulou A, Ziogas DC, Samarkos M, et al. Reactivation of tuberculosis in cancer patients following administration of immune checkpoint inhibitors: current evidence and clinical practice recommendations. J Immunother Cancer. 2019;7(1):239. doi: https://doi.org/10.1186/s40425-019-0717-7 DOI: https://doi.org/10.1186/s40425-019-0717-7
Suliman AM, Bek SA, Elkhatim MS, et al. Tuberculosis following programmed cell death receptor-1 (PD-1) inhibitor in a patient with non-small cell lung cancer. Case report and literature review. Cancer Immunol Immunother. 2021;70(4):935-44. doi: https://doi.org/10.1007/s00262-020-02726-1 DOI: https://doi.org/10.1007/s00262-020-02726-1
Tousif S, Singh Y, Prasad DV, et al. T cells from programmed death-1 deficient mice respond poorly to mycobacterium tuberculosis infection. PLoS One. 2011;6(5):e19864. doi: https://doi.org/10.1371/journal.pone.0019864 DOI: https://doi.org/10.1371/journal.pone.0019864
Barber DL, Sakai S, Kudchadkar RR, et al. Tuberculosis following PD-1 blockade for cancer immunotherapy. Sci Transl Med. 2019;11(475):eaat2702. doi: https://doi.org/10.1126/scitranslmed.aat2702 DOI: https://doi.org/10.1126/scitranslmed.aat2702
Tezera LB, Bielecka MK, Ogongo P, et al. Anti-PD-1 immunotherapy leads to tuberculosis reactivation via dysregulation of TNF-α. Elife. 2020;9:e52668. doi: https://doi.org/10.7554/elife.52668 DOI: https://doi.org/10.7554/eLife.52668
Bagcchi S. WHO's Global Tuberculosis Report 2022. Lancet Microbe. 2023;4(1):e20. doi: https://doi.org/10.1016/s2666-5247(22)00359-7 DOI: https://doi.org/10.1016/S2666-5247(22)00359-7
Van Eeden R, Rapaport BL, Smit T, et al. Tuberculosis infection in a patient treated with nivolumab for non-small cell lung cancer: case report and literature review. Front Oncol. 2019;9:659. doi: https://doi.org/10.3389/fonc.2019.00659 DOI: https://doi.org/10.3389/fonc.2019.00659
Shi J, Li J, Wang Q, et al. The safety and efficacy of immunotherapy with anti-programmed cell death 1 monoclonal antibody for lung cancer complicated with Mycobacterium tuberculosis infection. Transl Lung Cancer Res. 2021;10(10):3929-42. doi: https://doi.org/10.21037/tlcr-21-524 DOI: https://doi.org/10.21037/tlcr-21-524
Ministério da Saúde (BR). Protocolo de vigilância da infecção latente pelo Mycobacterium tuberculosis no Brasil. 2. ed. Brasília, DF: Ministério da Saúde; 2022.
Ministério da Saúde (BR). Tuberculose. Boletim Epidemiol [Internet]. 2023 [acesso em 2023 jun 1];Número Especial:1-64. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2023/boletim-epidemiologico-de-tuberculose-numero-especial-mar.2023/
Liu K, Wang D, Yao C, et al. Increased tuberculosis incidence due to immunotherapy based on PD-1 and PD-L1 blockade: a systematic review and meta-analysis. Front Immunol. 2022;13:727220. doi: https://doi.org/10.3389/fimmu.2022.727220 DOI: https://doi.org/10.3389/fimmu.2022.727220
Conselho Nacional de Saúde (BR). Resolução n° 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União, Brasília, DF. 2013 jun 13; Seção I:59.
Bae S, Kim YJ, Kim MJ, et al. Risk of tuberculosis in patients with cancer treated with immune checkpoint inhibitors: a nationwide observational study. J Immunother Cancer. 2021;9(9):e002960. doi: https://doi.org/10.1136/jitc-2021-002960 DOI: https://doi.org/10.1136/jitc-2021-002960
Ramakrishnan L. Revisiting the role of the granuloma in tuberculosis. nat rev immunol. 2012;12(5):352-66. doi: https://doi.org/10.1038/nri3211 DOI: https://doi.org/10.1038/nri3211
Langan EA, Graetz V, Allerheiligen J, et al. Immune checkpoint inhibitors and tuberculosis: an old disease in a new context. Lancet Oncol. 2020;21(1):e55-e65. doi: https://doi.org/10.1016/s1470-2045(19)30674-6 DOI: https://doi.org/10.1016/S1470-2045(19)30674-6
Xu J, Lin X, Liu W, et al. Lung adenocarcinoma with active pulmonary tuberculosis: a case report of successful immunotherapy and systematical review. Research Square [Preprint]. 2021 [posted 2021 set 28]. doi: https://doi.org/10.21203/rs.3.rs-936584/v1 DOI: https://doi.org/10.21203/rs.3.rs-936584/v1
Ahmed M, Tezera LB, Elkington PT, et al. The paradox of immune checkpoint inhibition re-activating tuberculosis. Eur Respir J. 2022;60:2102512. doi: https://doi.org/10.1183/13993003.02512-2021 DOI: https://doi.org/10.1183/13993003.02512-2021
Cantini F, Nannini C, Niccoli L, et al. Guidance for the management of patients with latent tuberculosis infection requiring biologic therapy in rheumatology and dermatology clinical practice. Autoimmun Rev. 2015;14(6):503-9. doi: https://doi.org/10.1016/j.autrev.2015.01.011 DOI: https://doi.org/10.1016/j.autrev.2015.01.011
Getahun H, Matteelli A, Abubakar I, et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J. 2015;46(6):1563-76. doi: https://doi.org/10.1183/2F13993003.01245-2015
Pahal P, Pollard EJ, Sharma S. PPD Skin Test [Internet]. Treasure Island: StatPearls Publishing; 2023. [acesso 2023 dez 12]. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK556037/
Lu M, Zhang L, Li Y, et al. Recommendation for the diagnosis and management of immune checkpoint inhibitor related infections. Thorac Cancer. 2020;11:805-9. doi: https://doi.org/10.1111/1759-7714.13313 DOI: https://doi.org/10.1111/1759-7714.13313
Bukamur H, Katz H, Alsharedi M, et al. Immune checkpoint inhibitor-related pulmonary toxicity: focus on nivolumab. South Med J. 2020;113(11):600-5. doi: https://doi.org/10.14423/SMJ.0000000000001166 DOI: https://doi.org/10.14423/SMJ.0000000000001166
Hamashima R, Uchino J, Morimoto Y, et al. Association of immune checkpoint inhibitors with respiratory infections: a review. Cancer Treat Rev. 2020;90:102109. doi: https://doi.org/10.1016/j.ctrv.2020.102109 DOI: https://doi.org/10.1016/j.ctrv.2020.102109
Cadranel J, Canellas A, Matton L, et al. Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer. Eur Respir Rev. 2019;28(153):190058. doi: https://doi.org/10.1183/16000617.0058-2019 DOI: https://doi.org/10.1183/16000617.0058-2019
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