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Mycobacterial infections due to PD-1 and PD-L1 checkpoint inhibitors
Kartik Anand1, Geetanjali Sahu2, Ethan Burns3
1Callahan Cancer Center, Great Plains Health, North Platte, Nebraska, USA kartikanand88@gmail.com.
Background:
Immune checkpoint inhibitors that block programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) have improved outcomes for many cancer subtypes but do exhibit toxicity, in the form of immune-related adverse events.
Objective:
The aim of this study was to investigate the emerging toxicities of PD-1 and PD-L1 inhibitors including acute or reactivation of tuberculosis (TB) and atypical mycobacterial infection (AMI).
Methods:
This study was completed as a retrospective review using the US Food and Drug Administration Adverse Events Reporting System (FAERS) for incidence of TB and AMI due to PD-1 and PD-L1 inhibitors compared with other FDA (Food and Drug Administration) approved drugs. The statistical methods included disproportionality signal analysis using the reporting OR (ROR) to compare cases. The 95% Wald CI was reported to assess the precision of the ROR.
Results:
Out of the 10 146 481 adverse events (AEs) reported to FAERS for all drugs between 1 January 2015 and 31 March 2020, 73 886 AEs were due to the five FDA approved PD-1/PD-L1 inhibitors. Seventy-two cases of TB were due to PD-1/PD-L1 inhibitors. Specifically, 45 cases (62.5%) due to nivolumab, 18 (25%) due to pembrolizumab, 5 (7%) due to atezolizumab and 4 (5.5%) due to durvalumab. There were 13 cases of AMI: 9 (69.3%) due to nivolumab, 2 (15.3%) due to pembrolizumab and 1 (7.7%) each due to durvalumab and atezolizumab. Avelumab was not attributed to any AE of TB or AMI. From analysis of the FAERS database, the calculated ROR for TB due to PD-1/PD-L1 inhibitors was 1.79 (95% CI, 1.42 to 2.26) (p<0.0001) and for AMI was 5.49 (95% CI, 3.15 to 9.55) (p<0.0001).
Conclusion:
PD-1/PD-L1 inhibitors used in the treatment of cancer subtypes is associated with increased TB and AMI risk. Although this complication is rare, clinicians using PD-1/PD-L1 inhibitors should be aware of the risks.
Insights
Immune checkpoint inhibitors targeting PD-1/PD-L1 increase the risk of tuberculosis (TB) and atypical mycobacterial infections (AMI). While rare, clinicians should monitor for these emerging toxicities in cancer patients.
Area of Science:
- Oncology
- Immunology
- Infectious Diseases
Background:
- Immune checkpoint inhibitors (ICIs) like PD-1/PD-L1 blockers improve cancer treatment outcomes.
- However, ICIs can cause immune-related adverse events (irAEs).
Purpose of the Study:
- To investigate the risk of tuberculosis (TB) and atypical mycobacterial infections (AMI) associated with PD-1/PD-L1 inhibitors.
- To compare the incidence of these infections with other FDA-approved drugs.
Main Methods:
- Retrospective review of the US Food and Drug Administration Adverse Events Reporting System (FAERS) database.
- Analysis of adverse events reported between January 1, 2015, and March 31, 2020.
- Disproportionality signal analysis using the Reporting Odds Ratio (ROR) with 95% Wald Confidence Intervals (CI).
Main Results:
- Out of over 10 million adverse events, 73,886 were linked to PD-1/PD-L1 inhibitors.
- 72 cases of TB and 13 cases of AMI were attributed to PD-1/PD-L1 inhibitors.
- The ROR for TB was 1.79 (95% CI, 1.42-2.26) and for AMI was 5.49 (95% CI, 3.15-9.55), both statistically significant.
Conclusions:
- PD-1/PD-L1 inhibitors are associated with an increased risk of TB and AMI in cancer patients.
- Although rare, these infections represent an emerging toxicity that clinicians must consider.
- Awareness of these risks is crucial for safe and effective cancer immunotherapy management.
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