Narrative review on ICIs in patients with viral infections and solid tumors
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Key Takeaway
Consider viral reactivation risk when using ICIs in patients with viral infections and solid tumors.
This is a narrative review that synthesizes evidence on the use of immune checkpoint inhibitors (ICIs) in patients with viral infections, including hepatitis B virus, hepatitis C virus, human immunodeficiency virus, human papillomavirus, and Epstein–Barr virus, who have solid tumors. The authors discuss how viruses reconfigure tumor immune landscapes, leading to heterogeneity in immunotherapy responses.
Key synthesized findings include potential effects on antitumor immune function, virological responses, and immunological changes suggestive of improved viral control. The review also addresses the risk of viral reactivation and immune-related adverse events (irAEs). However, no specific pooled effect sizes, sample sizes, or comparative outcomes are reported, as this is a qualitative synthesis.
The authors note limitations, including the risk of viral reactivation as a persistent concern. They emphasize the potential value of virus-specific immune profiling to guide individualized treatment strategies and the need to optimize the integration of ICIs with antiviral therapies.
Practice relevance is restrained, focusing on the need for careful patient selection and monitoring. The review does not provide trial-level details on interventions, comparators, or adverse event rates, and it calls for further research to clarify safety and efficacy in this population.
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View Original Abstract ↓
Immune checkpoint inhibitors (ICIs) have revolutionized the therapeutic landscape of diverse solid tumors; however, concurrent viral infections significantly influence their efficacy and safety profiles. By driving persistent antigen exposure, inducing T cell exhaustion, and remodeling the immunosuppressive tumor microenvironment (TME), viruses extensively reconfigure tumor immune landscapes, leading to marked heterogeneity in responses to immunotherapy. Emerging evidence indicates that patients infected with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), human papillomavirus (HPV), or Epstein–Barr virus (EBV) who receive ICIs therapy may not only regain antitumor immune function, but in some cases may also be associated with virological responses, immunological changes suggestive of improved viral control. However, the risk of viral reactivation remains a concern, particularly in the context of immune-related adverse events (irAEs) requiring immunosuppressive treatment. This review systematically summarizes the current clinical application of ICIs across different viral infection backgrounds and highlights recent advances in the underlying immunological mechanisms. Furthermore, we propose the potential value of virus-specific immune profiling in guiding individualized treatment strategies and emphasize the need to optimize the integration of ICIs and antiviral therapies from the perspective of systemic immune reprogramming.
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