Lung adenocarcinoma with active pulmonary tuberculosis: a case report of successful immunotherapy and systematical review

Abstract Immune checkpoint inhibitors (ICIs) have become widely used in the treatment of several malignancies, and get better clinical benefits in some patients with non-small cell lung cancer (NSCLC). However, in most of highquality clinical Randomized Controlled Trial (RCT) studies, only selected patients are needed. In Real-World Study (RWS), patients contracted simultaneously with NSCLC and Tuberculosis are common. TB reactivation during ICIs use is increasingly recognized and reported. Whether ICIs can be used in anti-tumor in patients with TB are rarely seen. Herein, we present a 67-year-old male active tuberculosis complicated with advanced non-small cell lung cancer (NSCLC) ALK-negative, EGFR wild, and PD-L1 immune histochemistry (IHC) strongly positive in 60–90% of tumor cells, on ongoing treatment with Pembrolizumab as a frstline anti-tumor therapy during anti-TB treatment. After two cycles of Pembrolizumab, the tumor response was evaluated PR, and TB well controlled. The patient is still on anti-TB and ICIs anti-tumor therapy, sputum smear and sputum culture remain negative, follow-up showed no relapse of tuberculosis infection or tumor progression. Our case shows that it may be feasible to combine anti-TB with ICIs for advanced lung cancer patients with active TB.