Evaluation of cancer patients receiving concurrent chemotherapy and antituberculosis treatment: Review and case series of a single-center experience

Abstract

Background/Aim: Cancer and tuberculosis are common in the world, and the intersection of these two diseases affects oncology practice inevitably. Fortunately, the co-occurrence of cancer and tuberculosis is rare and there are no guidelines for the management of therapy in these patients. The information on these patients is obtained from small-scaled studies. This study aimed to question the efficacy and safety of tuberculosis treatment in cancer patients receiving chemotherapy. Methods: Twenty-two patients who were treated with chemotherapy due to cancer and followed up and treated for concurrent tuberculosis in Diyarbakır Gazi Yaşargil Training and Research Hospital Medical Oncology Clinic between February 2009 and March 2021 were included in this retrospective case-control study. The clinical laboratory and treatment data of these patients were reviewed retrospectively. Then, the clinical, laboratory and treatment data of twenty-two cancer patients of the same age, who had the same stage cancer and received the same chemotherapy treatment but did not have tuberculosis disease were compared with the patients with tuberculosis. Thus, the efficacy, safety, and effect of tuberculosis treatment on cancer treatment were investigated. Results: Twenty-two patients were diagnosed with tuberculosis and cancer. Six (27.3%) patients were receiving single agent chemotherapy, 16 (72%) were receiving combination chemotherapy, and 5 (22.5%) were receiving a combination of chemotherapy and targeted therapy. While 10 (45.5%) patients were diagnosed with non-pulmonary tuberculosis, 12 (54.5%) patients were diagnosed with pulmonary tuberculosis. Among all patients, the rate of completion of antituberculosis treatment was 77.2%, and the success rate with initial antituberculosis agents was 72.7%. Except for elevated liver enzymes, nausea-vomiting and grade-3 neutropenia (P<0.001, P<0.001, P=0.012 respectively), there was no significant difference in toxicity between the patients with and without tuberculosis. The mortality rate in the first 6 months of anti-tuberculosis treatment was 18.2% in patients who received tuberculosis and cancer treatment, compared to 9.1% in cancer patients who did not receive tuberculosis treatment. There was no signifixant difference in the mortality rate in both groups at the end of 12-year follow-up period (P=0.658). Conclusion: Our results show that the combined use of chemotherapy and antituberculosis treatment in patients with cancer and tuberculosis is effective and safe.

Keywords

• Cancer
• Antituberculosis treatment
• Chemotherapy
• Tuberculosis

References

1. 1. Hyuna S, Jacques F, Rebecca L, Mathieu L, Isabelle S, Ahmedin J, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clın. 2021 May;71(3):209-49. doi: 10.3322/caac.21660.
2. 2. Mohsen N, Amanuel AA, Cristiana A, Kaja MA, Foad AA, Semaw FA, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017 Sep 16;390(10100):1151–210. doi: 10.1016/S0140-6736(17)32152-9.
3. 3. Cohen A, Mathiasen VD, Schon T, Wejse C, Christian W. The global prevalence of latent tuberculosis: a systematic review and metaanalysis. Eur Respir J. 2019 Sep 12;54(3):1900655. doi: 10.1183/13993003.00655-2019.
4. 4. World Health Organization. global tuberculosis report 2018. Geneva, Switzerland: World Health Organization https://www.who.int/tb/publications/global_report/en/ date of access:12.10.2021
5. 5. Finn OJ. Immuno-Oncology: Understanding the unction and dysfunction of the immune system in cancer. Annals of Oncology. 2012 Sep; 23 Suppl 8(Supp 8):viii6–viii9. doi: 10.1093/annonc/mds256
6. 6. Penn I, Starzl TE. Immunosuppression and cancer. Transplant Proc. 1973 Mar;5(1):943–47.
7. 7. Pedro CL, Jesús JLP, Virgínea de AF, Carmen RR, Francisco JO, José MRA. Direct and bystander radiation effects: a biophysical model and clinical perspectives. Cancer Lett. 2015 Jan 1;356(1):5-16. doi: 10.1016/j.canlet.2013.09.006.
8. 8. Cliffton EE, Irani BB. Pulmonary tuberculosis and cancer. N Y State J Med. 1970 Dec; 11:274–8.

9. 9. American Thoracic Society and the Centers for Disease Control and Prevention. Targeted Tuberculin Testing and Treatment of atent Tuberculosis İnfection. Am J Respir Crit Care 2000 Apr;161(4 Pt 2):S221-47. doi: 10.1164/ajrccm.161.supplement_3.ats600
10. 10. Matthew PC, Claire NAC, Cedric PY, Sonya C, Ian S, Dick M. et al. Risk of active tuberculosis in patients with cancer: a systematic review and meta-analysis. Clin Infect Dis. 2017 Mar 1;64(5):635-44. doi: 10.1093/cid/ciw838.
11. 11. Vento S, Lanzafame M. Tuberculosis and cancer: A complex and dangerous liaison. Lancet Oncol. 2011 Jun;12(6):520-2. doi: 10.1016/S1470-2045(11)70105-X.
12. 12. Slama K, Chiang CY, Enarson DA, Hassmiller K, Fanning A, Gupta P. Tobacco and tuberculosis: a qualitative systematic review and meta-analysis. Int J Tuberc Lung Dis. 2007 Oct;11(10):1049-61.
13. 13. Stephen DL, Alimuddin IZ. Tuberculosis. Lancet 2011 Jul 2;378(9785):57-72. doi: 10.1016/S0140-6736(10)62173-3
14. 14. Santiago B, James LM. The Potential contributions of chronic inflammation to lung carcinogenesis. Clin. Lung Cancer. 2003 Jul;5(1):46-62. doi: 10.3816/CLC.2003.n.021.
15. 15. Cennet Ş, Eyüp Ç, Burçin AÜ, Selahattin D. Image-guided biopsy-proven lung and skeletal tuberculosis cases mimicking malignancy. J Surg Med. 2020;4(9):761-5. doi: 10.28982/josam.784382
16. 16. Mei C, Qingming S. The Effect of Anti-cancer and antituberculosis treatments in lung ancer patients with active tuberculosis: a etrospective analysis. BMC Cancer. 2020 Nov 19;1121ç doi: 10.1186/s12885-020-07622-6
17. 17. Tomonori H, Yoshitaka T, Yuki H, Shoji H, Ayako T, Takayuki S. et al. Efficacy and safety of oncurrent anti cancer and anti-ttuberculosis chemotherapy in cancer patients with active mycobacterium tuberculosis: a retrospective study. BMC Cancer. 2018 Oct 12;18(1):975. doi: 10.1186/s12885-018-4889-1.
18. 18. T.C Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Tüberküloz Dairesi Başkanlığı Türkiye Verem Savaşı 2018 Raporu. hsgm.saglik.gov.tr/tr/tuberkuloz-yayinlar/tuberkuloz-db-raporlar.html
19. 19. Shwn-Huey S, Janice CP, Fung-Chang S, Wen-Chen T, Ya-Shin L, Chih-Yi C. Decreased survival among lung cancer patients with co-morbid tuberculosis and diabetes. BMC Cancer. 2012 May 12;174. doi: 10.1186/1471-2407-12-174
20. 20. Chin-Chung S, Kuang-Ming L, Yi-Chen C, Jhi-Joung W, Chung-Han H. The burdens of tuberculosis on patients with malignancy: incidence, mortality and relapse. Nature Scientific Reports (2019) Agust 15;9:11901. doi: 10.1038/s41598-019-483958
21. 21. Deog KK, Sei WL, Chul-Gyu Y, Young WK, Sung KH, Young-Soo S. et al. Clinical characteristics and treatment responses of tuberculosis in patients with malignancy receiving anticancer chemotherapy. Chest. 2005 Oct;128(4):2218-22. doi: 10.1378/chest.128.4.2218.
22. 22. Mei C, Qingming S. The effect of Anti-cancer and antituberculosis treatments in lung cancer patients with active tuberculosis: a retrospective analysis. BMC Cancer (2020) Nov 19;20:1121. doi: 10.1186/s12885-020-07622-6
23. 23. Ashok R, Michael PP, Scott F, Hannah MJ, Jean-Eric C, Myriam R, et al. The Effects of CYP3A4 Inhibition on Erlotinib pharmacokinetics: computer-based simulation (simcyp) predicts in vivo metabolic ınhibition. Eur J Clin Pharmacol. 2008 Jan;64(1):31-41. doi: 10.1007/s00228-007-0396-z. Epub 2007 Nov 14.