Herpes zoster in lung cancer patients treated with PD-1/PD-L1 inhibitors

Abstract

Background: Herpes zoster (HZ) occurs mostly in elderly and immunocompromised individuals. Immune reconstitution may be associated with the pathogenesis of HZ. As immune checkpoint inhibitor (ICI) treatment amplifies the immune response, use of ICI may increase the incidence of HZ. There have been few studies of HZ in lung cancer patients treated with ICI. This study was performed to investigate the frequency of HZ in lung cancer patients who received ICI or cytotoxic chemotherapeutic agents. Methods:We searched the electronic medical records for lung cancer patients receiving anticancer drug therapy at our hospital, who developed HZ between April 2011 and June 2020. Results:The review identified 80 patients with a history of ICI treatment (ICI group) and 356 who had been treated with cytotoxic chemotherapeutic agents alone (non-ICI group). Among the 20 patients who developed HZ, 4 (5.0%) belonged to the ICI group and 16 (4.5%) to the non-ICI group (P=0.782). After exclusion of patients aged 65 years and older, to avoid effects of advanced age on the results, the ICI and non-ICI groups consisted of 24 and 81 patients, respectively. In total, 3 of the 24 patients (12.5%) in the ICI group and 1 of the 81 (1.2%) patients in the non-ICI group developed HZ (P=0.0365).Conclusions: There was no significant difference in the rate of HZ between lung cancer patients treated with ICI and those treated with cytotoxic chemotherapy alone. However, patients younger than 65 years treated with ICI might be at increased risk of HZ. Because this is a retrospective small study, further prospective observational studies are needed.

Reactivation of Varicella-Zoster Virus in Patients with Lung Cancer Receiving Immune Checkpoint Inhibitors: Retrospective Nationwide Population-Based Cohort Study from South Korea

“…We used data on a nationwide population from the HIRA health insurance claims database. A similar study investigating the association between the rate of HZ and ICI treatment was conducted in Japan; however, it cannot be considered representative because of the small number of participants (n = 436) included in the study [14]. Multivariate analysis was conducted to control potential confounders after adjusting for a range of variables in the risk factor analysis.…”

“…Limited studies have been performed on the impact of ICIs on the reactivation of VZV, which is influenced by decreased CMI, specifically with regard to T-cell immunity. Published studies primarily consist of sporadic case reports [11][12][13] and retrospective analyses with small patient cohorts from a single center [14].…”

Acute retinal necrosis in a patient with cervical malignant tumor treated with sintilimab: a case report and literature review

“…Regarding the causes of ARN in patients receiving sintilimab, it may related to ICI-induced VZV reactivation. Firstly, immune reconstitution inflammatory syndrome (IRIS) caused by ICI may increase the incidence of VZV ( 9 ). Secondly, activated T lymphocytes infiltrate non-cancerous tissues and increase existing autoantibodies and inflammatory cytokines.…”

“…This report describes a case of ARN secondary to VZV during immunotherapy with sintilimab injection for cervical cancer. It is thought that treatment with ICIs may lead to reactivation of the VZV ( 8 , 9 ). As far as we know, no such adverse reaction has been reported previously.…”

The immunogenicity and the safety of the adjuvanted glycoprotein E (gE)-based recombinant vaccine against herpes zoster (RZV) in cancer patients during immunotherapy

“…The authors have demonstrated no significant difference in the rate of HZ between the two treatments (5% versus 4.5%, respectively, p = .782), while the younger patients (<65 years old) on ICIs have presented a higher risk of HZ than those treated with chemotherapy alone (12.5% versus 1.2%, respectively, p = .0365). 14 …”