Should immune checkpoint inhibitors be contraindicated in lung cancer patients with latent tuberculosis?

Patients with a positive IGRA (in the absence of findings suggestive of active TB disease) should be considered for treatment of latent TB and should be evaluated to exclude active TB (detailed history, physical examination and imaging). Since there is sparse evidence suggesting that inhibition of PD-1/PD-L1 pathway may reactivate TB, screening for LTBI should be considered before initiating ICIs, specifically in cancer patients with additional independent risk factors (diabetes, chronic renal failure, exposure to MTB endemic regions and immunosuppression). The vast majority of new TB cases occurred in developing countries like India, Philippines, Pakistan, Nigeria, Bangladesh and South Africa (18). [...]cancer patients in these countries face racial and financial obstacles to cancer care. [...]due to the high cost per-quality life-year gained with immunotherapy treatment, the access to these expensive drugs can be difficult in many developing countries, even for eligible patients (20). [...]despite the limited percentage of patients receiving immunotherapy in developing countries compared with developed ones, many immigrants are being treated with the standard of acre in more developed countries. [...]screening for LTBI with IGRA or TST is recommended among immigrants from endemic regions or high-risk individuals, before initiating ICI treatment.