How would you manage a patient with newly diagnosed locally advanced NSCLC and concurrent, active tuberculosis on anti-TB therapy?

After initiation of anti-TB treatment and 3 negative AFB smears, would you initiate concurrent chemoRT? Would you give sequential RT then chemo to give patient more time on the anti-TB treatment before adding immunosuppressive chemotherapy?

1 Answer

Mednet MemberInvited Expert

Medical Oncology · University of California, Los Angeles

Answered on

Excellent question @Dr. First Last!

Assuming the patient is otherwise a good candidate for concurrent chemoRT, my bias would be to proceed with concurrent therapy once the 3 negative AFBs are available, rather than pursue sequential RT then chemo.

This recommendation is based upon the observation that concurrent chemoRT leads to improved outcomes for patients with locally advanced NSCLC, compared to sequential RT then chemo:

Curran et al, PMID 21903745

Coupled with the fact that in small data sets, concurrent anti-TB and chemotherapy has been shown to be safe:

Hirashima et al., PMID 30314434

As such, I would not want to impair the patient's chances of being cured from his/her locally advanced NSCLC and would proceed with concurrent chemoRT, as...

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How would you manage a patient with newly diagnosed locally advanced NSCLC and concurrent, active tuberculosis on anti-TB therapy?

How would you manage a patient with locally advanced NSCLC and active tuberculosis on anti-TB therapy?