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.