Qingbo Wang on Comprehensive Treatment Strategies for Tuberculosis-Associated Lung Cancer – Mediamedic

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“CCHIO 2024 – Dr. Qingbo Wang: Comprehensive Treatment Strategies for Tuberculosis-Associated Lung Cancer.

At the 2024 Chinese Congress of Holistic Integrative Oncology (CCHIO), during the Infectious Tumors Subcommittee session, Dr. Qingbo Wang from The Second Hospital of Nanjing presented a report titled ‘Comprehensive Treatment Strategies for Tuberculosis-Associated Lung Cancer.’

The presentation explored the epidemiology, diagnostic challenges, and treatment strategies for patients with coexisting tuberculosis (TB) and lung cancer.

Oncology Frontier: Tuberculosis (TB) and lung cancer are two common and severe respiratory diseases. They are often interrelated in pathogenesis and clinical presentation. Could you share the prevalence of coexisting TB and lung cancer in clinical practice?

Dr. Qingbo Wang: Tuberculosis has not been eradicated and continues to have a notable incidence in China. It is an infectious disease caused by Mycobacterium tuberculosis, and long-term TB infection can increase the risk of lung cancer. Lung cancer, one of the most common malignancies, often coexists with TB due to shared risk factors.

Patients with compromised immune systems—whether due to cancer itself or cancer treatment—are particularly prone to TB infections. Data indicates that TB increases lung cancer risk tenfold compared to the general population.

Approximately 2.6% of TB patients in China are reported to have coexisting lung cancer. Conversely, the prevalence of active TB among lung cancer patients is about 25% higher than in healthy individuals, with a comorbidity rate ranging from 2% to 21%, though precise statistics remain unclear.

Oncology Frontier: The overlapping symptoms of TB and lung cancer can delay diagnosis, leading to missed opportunities for early treatment. How can clinicians accurately diagnose coexisting TB and lung cancer in the early stages?

Dr. Qingbo Wang: TB and lung cancer share similar clinical symptoms, such as chest tightness, chest pain, fever, hemoptysis, and coughing, making timely differential diagnosis crucial.

TB leading to lung cancer often occurs during TB treatment when new pulmonary nodules, soft tissue masses, or changes in previously stable TB lesions emerge, such as enlargement or imaging features like spiculation and lobulation. Hemorrhagic pleural effusion is another indicator. In such cases, timely pathological diagnosis is essential.

Lung cancer leading to TB infection typically manifests during cancer treatment, such as radiotherapy, chemotherapy, immunotherapy, or targeted therapy.

Symptoms like low-grade fever, night sweats, hemoptysis, or worsening cough, along with imaging findings of solitary or novel lesions, particularly in upper lung lobes, should raise suspicion for coexisting TB. Further investigation is critical to confirm the diagnosis.

Oncology Frontier: Treating coexisting TB and lung cancer presents complex challenges, as their treatments may conflict. How should clinicians balance the treatment priorities, select appropriate medications, and monitor patient outcomes?

Dr. Qingbo Wang: Managing coexisting TB and lung cancer is indeed challenging. Chemotherapy, often used in lung cancer, is also an effective TB treatment. The approach depends on the patient’s condition. When active TB is detected during lung cancer treatment, priority is given to managing TB.

Anti-TB therapy is initiated for 2–3 weeks before cancer treatments such as chemotherapy. Targeted drugs for lung cancer can often be administered concurrently with anti-TB medications, but close monitoring for drug interactions and toxicity is crucial.

Immunotherapy requires heightened vigilance for TB infection, as its adverse effects, such as immune-related pneumonitis, complicate TB management. Corticosteroids used to manage pneumonitis must be cautiously applied due to TB risks. Drug-induced liver toxicity from either treatment further complicates the situation.

Some anti-TB drugs, like rifampin, can reduce the plasma concentration of targeted therapies like gefitinib, lowering their efficacy. Clinicians must carefully evaluate potential drug-drug interactions to mitigate these risks. In all cases, clinicians should follow evidence-based guidelines, draw on accumulated clinical experience, and individualize treatment plans to optimize outcomes.

Oncology Frontier: Could you share insights into your team’s ongoing research in this field?

Dr. Qingbo Wang: Our team is conducting foundational and clinical research on the intersection of infections and tumors, particularly focusing on coexisting TB and lung cancer. Many patients and their families worry about delaying cancer treatment while managing active TB.

We are investigating whether simultaneous or sequential interventions for TB and lung cancer impact overall survival (OS) or quality of life. Mechanistically, we are exploring how Mycobacterium tuberculosis infection contributes to lung cancer or other malignancies.

We are collaborating with national experts to establish consensus guidelines for managing coexisting TB and lung cancer. These guidelines aim to provide clinicians with a standardized approach to this challenging condition.

By bridging clinical and mechanistic insights, our ultimate goal is to create evidence-based strategies that improve patient outcomes and provide clarity for healthcare providers facing this dual challenge.

Dr. Qingbo Wang

• Chief Physician, Director of the Oncology Department, The Second Hospital of Nanjing
• Executive Committee Member, Infectious Tumor Subcommittee, Chinese Anti-Cancer Association (CACA)
• Founding Chairperson, First Infectious Tumor Subcommittee, Jiangsu Anti-Cancer Association.”

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