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Clinical Analysis of Pulmonary Nontuberculous Mycobacterial Infection in Patients With Pre-Existing Stage II-IV Lung
Juan Li1,2, Junsheng Fan1,2, Zhili Tan1,2
1Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Abstract:
Immune checkpoint inhibitors (ICIs) targeting programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) have improved cancer outcomes but can induce immune-related adverse events, including mycobacterial infections. This study retrospectively analysed pulmonary nontuberculous mycobacteria (NTM) infection in 91 patients with pre-existing stage II-IV lung cancer at Shanghai Pulmonary Hospital between June 2015 and June 2024. Among these patients, 78.0% [71/91] were male, and 16.5% [15/91] were receiving ICIs monotherapy at the time of initial pulmonary NTM infection diagnosis (ICIs group). Compared with the non-ICIs group, ICIs-treated patients developed pulmonary NTM infection earlier (median time: 12 months [IQR, 6-18] vs. 21.5 months [IQR, 13-30]; p = 0.004), and had a higher proportion of rapid-growing NTM isolates (73.3% [11/15] vs. 30.3% [23/76]; p = 0.003), predominantly Mycobacterium abscessus complex (40.0% [6/15]). In contrast, Mycobacterium avium complex was the predominant NTM species in the non-ICIs group (71.1% [54/76]). During 12 months of anti-NTM therapy, the ICIs group showed a lower cumulative sputum culture conversion rate (36.4% [4/11] vs. 59.6% [31/52]; p = 0.19) and a longer median time to initial sputum culture conversion (12 months vs. 6 months; p = 0.13), though these differences were not statistically significant. The most commonly administered ICIs drugs were tislelizumab (40.0% [6/15]) and sintilimab (26.7% [4/15]). These findings suggest that ICIs may be associated with earlier development of pulmonary NTM infection in lung cancer patients. Future prospective studies with larger sample sizes are needed to validate this conclusion.
Insights
Immune checkpoint inhibitors (ICIs) may accelerate the onset of pulmonary nontuberculous mycobacteria (NTM) infections in lung cancer patients. Patients on ICIs experienced earlier NTM diagnosis and a higher prevalence of rapid-growing NTM species.
Area of Science:
- Oncology
- Infectious Diseases
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) targeting PD-1/PD-L1 improve cancer outcomes but can cause immune-related adverse events.
- Mycobacterial infections, including nontuberculous mycobacteria (NTM), are potential adverse events associated with ICI therapy.
Purpose of the Study:
- To investigate the association between ICI use and the characteristics of pulmonary NTM infections in lung cancer patients.
- To compare the clinical presentation, NTM species, and treatment outcomes in lung cancer patients with and without ICI treatment.
Main Methods:
- Retrospective analysis of 91 lung cancer patients diagnosed with pulmonary NTM infection between June 2015 and June 2024.
- Patients were divided into an ICI group (receiving ICI monotherapy) and a non-ICI group.
- Comparison of time to NTM diagnosis, NTM species, and sputum culture conversion rates between the two groups.
Main Results:
- The ICI group (15 patients) developed pulmonary NTM infection earlier (12 vs. 21.5 months) and had a higher proportion of rapid-growing NTM (73.3% vs. 30.3%), predominantly Mycobacterium abscessus complex.
- The non-ICI group predominantly had Mycobacterium avium complex.
- While not statistically significant, the ICI group showed trends towards lower sputum culture conversion rates (36.4% vs. 59.6%) and longer time to conversion (12 vs. 6 months).
Conclusions:
- ICI therapy may be associated with an earlier onset of pulmonary NTM infections in lung cancer patients.
- Rapid-growing NTM species, particularly Mycobacterium abscessus complex, are more common in patients treated with ICIs.
- Further prospective studies are warranted to confirm these findings and elucidate the underlying mechanisms.
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