We experienced 3 cases of acute development of Mycobacterium avium complex lung disease (MAC-LD) in patients with lung cancer on immune checkpoint inhibitors. NIH There are two main clinical presentations for NTM infection, which means that the symptoms and signs associated with this disorder are expressed in two specific ways.  |  Although lung cancer was diagnosed, CT images only showed bilateral emphysema but no bronchiectasis or nodules. Cumulative experience will reveal the complete picture. Previous reports indicate that development of tuberculosis during ICI immunotherapy has become an emerging concern [4–7]. See this image and copyright information in PMC. Epub 2020 Mar 2. Comparison of DNA Methylation Profiles of Hemostatic Genes between Liver Tissue and Peripheral Blood within Individuals. Interrelational changes in the epidemiology and clinical features of nontuberculous mycobacterial pulmonary disease and tuberculosis in a referral hospital in Japan. Untreated patients with a nodular bronchiectatic form of Mycobacterium avium complex (MAC) suffer long deterioration in the long run despite their lack of symptoms, a new Korean study shows.. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. The aim of this study was to identify the clinical features of MAC … We believe in a … MAC infection may not always progress into lung disease, but the likelihood of this infection turning into a lung disease is higher for those suffering from an underlying lung condition or AIDS. Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease. In actual clinical settings, treatment with anti-PD-1/PD-L1 antibodies is expected to show similar responses. All patients had advanced lung cancer and received cytotoxic chemotherapy before treatment with ICIs. The airways can lose their ability to clear mucus and the mucus that accumulates within the airways can serve as a nutrient source and home for NTM, helping it to evade the immune system. doi: 10.1016/j.ccm.2014.10.002. The most common lung cancer types were adenocarcinoma (six patients) followed by … Pulmonary MAC infection is associated with chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), chronic bronchitis, bronchiectasis, cystic fibrosis, and lung cancer… Zhongguo Dang Dai Er Ke Za Zhi. Abbreviations: ICI, immune checkpoint inhibitor; MAC, Mycobacterium avium complex; nabPTX, nanoparticle albumin-bound paclitaxel; NE, not evaluated; PD-L1, programmed cell death–ligand 1. aTime from initiation of immune checkpoint inhibitor therapy to diagnosis of Mycobacterium avium complex lung disease. Keywords: Am. Get the latest public health information from CDC: https://www.coronavirus.gov. Published by Oxford University Press on behalf of Infectious Diseases Society of America. Clinics are held three times a week, and are staffed by respiratory physicians, thoracic surgeons, radiation oncologists and medical oncologists, all of whom are recognised for their particular expertise in lung … The proportion of women (52% vs 30%; P = 0.0274) and patient age (72 years vs 69 years; P = 0.0380) were significantly higher in the MAC-positive/other NTM-negative lung cancer group (n = 25) than in the MAC-negative/other NTM-negative lung cancer group (n = 1223). Eight patients had structural lung disease that can predispose to MAC pulmonary disease, including bronchiectasis (23.0%) and COPD (46.2%). Second-line therapy with nivolumab was initiated. MAC infection is not contagious. Epub 2016 Mar 22. -, Prevots D.R., Marras T.K. Physicians should be cautious toward the development of MAC-LD in patients on immunotherapy with ICIs, especially in countries such as Japan, which has a high burden of NTM. CT images acquired during atezolizumab therapy revealed rapidly worsening right lower lobe infiltration. The median time to MAC-LD diagnosis from induction of initial ICI (range) was 17 (17–19) months. Urabe N, Sakamoto S, Sano G, Ito A, Homma S. J Infect Chemother. In people with … Of them, records for 1258 that had undergone bronchoscopy together with sampling for mycobacterial culture were reviewed. Follow-up data for patients with lung cancer but without MACLD were reviewed for subsequent development of MACLD. Kamata H, Asakura T, Suzuki S, Namkoong H, Yagi K, Funatsu Y, Okamori S, Uno S, Uwamino Y, Fujiwara H, Nishimura T, Ishii M, Betsuyaku T, Hasegawa N. BMC Pulm Med. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. We performed a systematic review of the published literature on five-year all-cause mortality in patients with MAC lung disease… Nontuberculous mycobacterial lung disease prevalence at four integrated health care delivery systems. In their concluding remarks, the authors stated that additional cases of panhypopituitarism with pulmonary MAC … In critical COVID-19 -- about 5% of total cases -- the infection can damage the walls … Multiple cases of tuberculosis were suspected reactivation of latent infection. A 66-year-old man was diagnosed with stage 4a advanced squamous cell carcinoma of the right upper lung lobe. He attained 3 years of progression-free survival. The most common type of NTM bacteria in the U.S. is Mycobacterium avium complex (MAC). NLM HHS Most people who get MAC infections are those living with HIV/AIDS, certain cancers, and lung diseases like chronic obstructive pulmonary disease, cystic fibrosis, or bronchitis. A 66-year-old woman underwent surgical resection of right lower-lobe lung adenocarcinoma. The incidence of Mycobacterium avium complex (MAC)-positive respiratory specimen cultures and MAC lung disease (MACLD) is increasing worldwide. An 80-year-old man was diagnosed with stage 3a right upper lobe non–small cell lung cancer by bronchoscopy. The mean age at diagnosis of MAC-LD and lung cancer was 63.6 and 74.4 years, respectively. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. However, tumor progression was confirmed after 3 months. 2005;80(1):25–30. He received 1 cycle of combined carboplatin and nanoparticle albumin–bound paclitaxel (nabPTX) therapy, followed by radiotherapy (66 Gy). Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Correspondence: Kohei Fujita, MD, PhD, Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan, 1-1, Fukakusa-Mukaihata, Fushimi-Ku, Kyoto, Japan (. Ann. Morimoto K., Iwai K., Uchimura K., Okumura M., Yoshiyama T., Yoshimori K., Ogata H., Kurashima A., Gemma A., Kudoh S. A steady increase in nontuberculous mycobacteriosis mortality and estimated prevalence in Japan. Well-designed population-based studies are required to investigate such causal associations. Flow diagram of patients with lung cancer receiving bronchoscopy between 2003 and 2011. Pulmonary non-tuberculous mycobacterial infections: current state and future management. Respir Med. These data suggested that Th1 function with anti-PD-1/PD-L1 antibodies might cause the development of tuberculosis. Some authors have suggested the development of tuberculosis to be similar to immune reconstitution inflammatory syndrome [4, 7]. Clin. Epidemiology of human pulmonary infection with nontuberculous mycobacteria: a review. However, people with immune systems that do not work well (from HIV/AIDS or certain cancers for example) or people with lung disease (such as chronic obstructive pulmonary disease … Two consecutive sputum cultures were positive for Mycobacterium intracellulare at the 17th cycle of nivolumab therapy. Of course, the odds are not in favor of anyone with "other" chronic conditions including heart disease, diabetes, those fighting cancer, and those with chronic lung … The medical records of 1382 untreated lung cancer patients between 2003 and 2011 were collected using our hospital database. Because of adverse events, her chemotherapy regimen was revised to gemcitabine. The following alternate interpretation is also important. A diagnosis of MAC-LD was established, and specific treatment for MAC was initiated along with continued nivolumab therapy. Dis. This retrospective study aimed to assess the association between MAC culture-positive bronchoscopy specimens and lung cancer. Please check for further notifications by email. Although lung cancer was diagnosed, CT images showed bilateral emphysemas but no bronchiectasis or nodules. The great majority of NTM lung disease in the U.S. is caused by MAC… mycobacterium avium complex pulmonary disease (mac/mai) and/or bronchiectasis. Critical Cases. The threat of mycobacterial infection has been particularly alarming because of multiple reported cases [4–7]. All authors: no reported conflicts of interest. The Presence of Coexisting Lung Cancer and Non-Tuberculous Mycobacterium in a Solitary Mass. [Nontuberculous Mycobacterial Pulmonary Disease - The New ATS/ERS/ESCMID/IDSA Guideline]. The website is designed to be informative and encourage you to be part of the solution of MAC lung disease. 2020 May;39(5):799-826. doi: 10.1007/s10096-019-03771-0. Of the 29 patients with NTM and lung cancer, 62% had Mycobacterium avium complex as the pathogenic organism. Chest Med. Patient characteristics were compared between those with MAC-positive/other nontuberculous mycobacteria (NTM)-negative bronchial washings and those with MAC-negative/other NTM-negative bronchial washings. Four (30.8%) had no apparent immunosuppression or other risk factor(s) for MAC pulmonary disease. Epub 2018 Jul 25. Crit. Financial support. MarinMarcus. Four (30.8%) had no apparent immunosuppression or other risk factor(s) for MAC … © The Author(s) 2020. Advanced age; Bronchoscopy; Culture; Female; Lung cancer; Mycobacterium avium complex; Mycobacterium avium complex lung disease. 2014;11(1):1–8. Thank you for submitting a comment on this article. MAC culture-positive bronchial washing is positively associated with lung cancer. 2011;17(3):343–349. Results: -, Simons S., van Ingen J., Hsueh P.R., Van Hung N., Dekhuijzen P.N., Boeree M.J., van Soolingen D. Nontuberculous mycobacteria in respiratory tract infections, eastern Asia. Mycobacterium avium-intracellulare infection (MAI) is an atypical mycobacterial infection, i.e. Moreover, they received thoracic radiotherapy before the pathogenesis of MAC-LD. J. Respir. Female sex and advanced age, but not lung cancer characteristics, were found to be associated with MAC infection in patients with lung cancer. A previous report suggested a favorable effect of nivolumab for the treatment of Mycobacterium abscessus lung disease [9]. Among the several types of irAEs, cases of infectious diseases have been increasing steadily [3]. As the third-line therapy, he received 7 cycles of docetaxel and, subsequently, fourth-line therapy with atezolizumab after docetaxel failure. Please enable it to take advantage of the complete set of features! Your comment will be reviewed and published at the journal's discretion. Epub 2019 May 8. When occam's razor can fail- active mycobacteria infection and lung cancer: A case of neuroendocrine lung cancer diagnosed in the setting of refractory mycobacterium avium-intracellulare. 2020 Mar;12(3):142-149. doi: 10.14740/jocmr4058. doi: 10.1513/AnnalsATS.201303-067OC. The Lung Cancer Stream provides multidisciplinary care including diagnosis and treatment for cancers of the lung, thymus and mesothelioma. This retrospective study aimed to assess the association between MAC culture-positive bronchoscopy specimens and lung cancer. Alternatively, ICI immunotherapy might initiate a state of autoimmunity that mimics diseases like rheumatoid arthritis, which are known to be strongly associated with NTM-LD. Epub 2017 Nov 6. Get the latest research from NIH: https://www.nih.gov/coronavirus. Clinical characteristics and treatment outcomes of pleural effusions in patients with nontuberculous mycobacterial disease. J Korean Med Sci. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Chin KL, Sarmiento ME, Alvarez-Cabrera N, Norazmi MN, Acosta A. Eur J Clin Microbiol Infect Dis. Although the precise mechanisms underlying MAC-LD are unknown, anti-PD-1/PD-L1 antibodies are known to have possible antimicrobial effects that are mediated by upregulation of T-cell-mediated immunity [8]. Potential conflicts of interest. I… Is tomosynthesis an ingenious scheme for bronchoscopic diagnosis of lung nodules? The threat of mycobacterial infection has been particularly alarming because of multiple reported cases [ 4–7 ]. 2017 Dec;133:36-41. doi: 10.1016/j.rmed.2017.11.005. After 15 cycles of nivolumab, she developed wet cough with excessive sputum. Although immune checkpoint inhibitors manifest drastic effects, unique adverse events, including skin rash, hepatotoxicity, and endocrine disturbances, are known to occur during treatment. A similar presentation is expected of nontuberculous mycobacterial infection; however, to date, no paper has reported the development of nontuberculous mycobacterial infection. He was diagnosed with MAC-LD; specific treatment was initiated for MAC alongside the atezolizumab therapy. These events are termed immune-related adverse events (irAEs). Introduction: Results We identified 13 patients with MAC pulmonary disease and prior lung cancer, including 4 men and 9 women. In this study, CT images were retrospectively reviewed to assess possible changes of MAC-LD predating ICI immunotherapy. At the 23rd cycle of atezolizumab therapy, he developed wet cough and excessive sputum production. 2016 May;31(5):649-59. doi: 10.3346/jkms.2016.31.5.649. Soc. Computed tomography (CT) images acquired at that time showed no bronchiectasis or nodules in the bilateral lobes. Two consecutive sputum cultures at the 24th cycle of atezolizumab were positive for M. avium and M. intracellulare. Therefore, it is unclear whether MAC-LD developed from reactivation of existing disease or was a de novo infection. Three Antibiotic Therapies for Pulmonary Mycobacterium Avium Complex Disease Rochester, MN The purpose of this study is to determine whether 2-drug therapy is non-inferior to 3-drug therapy against pulmonary mycobacterium avium complex (MAC) disease… Clin Case Rep. 2018 Sep 27;6(11):2156-2159. doi: 10.1002/ccr3.1813. We report 3 cases of acute Mycobacterium avium complex lung disease during immunotherapy with ICIs. 2017 Dec 13;17(1):198. doi: 10.1186/s12890-017-0544-x. Two consecutive sputum cultures at the fourth cycle of atezolizumab therapy were positive for M. intracellulare, and a diagnosis of MAC-LD was established. However, disease progression was confirmed after 6 cycles of nivolumab therapy. These may emerge as thought-provoking cases. However, because of severe debilitation, treatment for MAC-LD was not initiated and atezolizumab immunotherapy was discontinued. Immunotherapy with immune checkpoint inhibitors (ICIs), while ameliorating lung cancer, can cause infectious diseases, including tuberculosis, in addition to immune-related noninfectious complications. CT images revealed multiple reticulonodular infiltrates in the lower left lung lobe. Patient consent. USA.gov. Japan has one of the highest burdens of NTM globally [13, 14]. The mean age at diagnosis of MAC-LD and lung cancer was 63.6 and 74.4 years, respectively. Conclusion: Materials and methods: All of our patients had advanced-stage lung cancer and had received relatively long-term treatment, including cytotoxic chemotherapy; therefore, the influence of both the cancer and the treatment in the development of MAC-LD cannot be ignored. 2018 Oct;24(10):822-827. doi: 10.1016/j.jiac.2018.06.014. This site needs JavaScript to work properly. Unlike the others, NTM lung disease is not known to be contagious. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. 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