title: Reactivation of tuberculosis during temsirolimus therapy.
abstract: Reactivation of tuberculosis is rare in patients receiving chemotherapy for solid tumours, and poorly documented in patients receiving molecular targeted therapy. We report on a patient with metastatic renal-cell carcinoma treated with temsirolimus, who developed respiratory symptoms and mild fever after 6 weeks of treatment. CT-scan and laboratory tests were consistent with reactivation of tuberculosis. The patient received anti-tuberculosis therapy including rifampicin, a potent CYP3A4/5 inducer. After introduction of rifampicin-based treatment, the patient experienced tumour progression, leaving questionable the potential pharmacokinetic interaction between rifampicin and temsirolimus, a substrate for CYP3A4.
authors.affiliation: Department of Medical Oncology, Cochin Teaching Hospital, Paris Descartes University, AP-HP, 27, rue du Faubourg Saint Jacques, F75014, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Coriat
authors.forename: Olivier
authors.initials: O
authors.lastname: Mir
authors.forename: Stanislas
authors.initials: S
authors.lastname: Ropert
authors.forename: Pierre
authors.initials: P
authors.lastname: Loulergue
authors.forename: Bertrand
authors.initials: B
authors.lastname: Billemont
authors.forename: François
authors.initials: F
authors.lastname: Goldwasser
mesh_terms: D000369:Aged, 80 and over; D000904:Antibiotics, Antitubercular / Q000494:pharmacology / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000378:metabolism / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000473:pathology; D051544:Cytochrome P-450 CYP3A / Q000096:biosynthesis / Q000187:drug effects / Q000378:metabolism; D004347:Drug Interactions; D004790:Enzyme Induction / Q000187:drug effects; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology; D008297:Male; D009362:Neoplasm Metastasis; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use*; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000378:metabolism / Q000627:therapeutic use; D014376:Tuberculosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000904:Antibiotics, Antitubercular; D000970:Antineoplastic Agents; C401859:temsirolimus; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human; D012293:Rifampin; D020123:Sirolimus