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Case based discussions
Tuberculosis associated with Triplet therapy for lung cancer
  1. Danielle Crawley1,
  2. Ronan A Breen2,
  3. Paul T Elkington3,
  4. Eleni Karapanagiotou4
  1. 1 Research Oncology, King's College London, London, UK
  2. 2 Thoracic Medicine, Guy's and St Thomas NHS Trust, London, UK
  3. 3 Thoracic Medicine, University of Southampton, Southampton, UK
  4. 4 Medical Oncology, Guy's and St Thomas NHS Trust, London, UK
  1. Correspondence to Dr Danielle Crawley, Research Oncology, King's College London, London SE1 9RT, UK; danielle.crawley{at}


We report the first case of TB associated with triplet therapy (chemotherapy and immunotherapy concurrently) for lung cancer, developing just 44 days after treatment initiation. We feel that several important learning points arise from the discussion that are likely to be very relevant to the broad readership of Thorax, and have important clinical and scientific implications. In the three discussion paragraphs, we highlight that: 1) Triplet therapy is now standard first-line treatment for inoperable lung cancer. 2) TB reactivation is increasingly recognised as an adverse effect of immune checkpoint inhibition, but sending diagnostic samples is critical to avoid a missed diagnosis. 3) These insights from novel cancer immunotherapies are challenging the traditional views of the host-pathogen interaction in TB, with wide implications for future control strategies. We propose that the cases reported in the literature are likely to be the tip of the iceberg as most people with lung cancer managed with antiprogrammed death-1 agents who develop new lung lesions will be treated with standard antibiotics and then palliated when they do not respond.

  • lung cancer chemotherapy
  • lung cancer
  • non-small cell lung cancer
  • tuberculosis

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.