Abstract: Immune checkpoint inhibitors (ICIs) are being widely applied in the treatment of various malignancies, significantly prolonging survival and improving quality of life. However, consequent immune-related adverse events have emerged as new clinical challenges. As a high-burden country for tuberculosis (TB), China faces particular concern regarding the impact of ICIs therapy on TB reactivation in cancer patients. Based on the detection principles of the TB interferon-γ release assay (TB-IGRA), this review explores its potential value in predicting ICIs efficacy and proposes a management algorithm for pulmonary TB patients undergoing ICIs treatment, aiming to maximize clinical benefits while ensuring safety.