HIV Status Does Not Influence Anal, Lung Cancer Survival

HIV-positive patients with anal cancer or lung cancer may expect to achieve similar survival to that of patients without the virus

medwireNews: Results from two studies may help guide the management of HIV-positive patients who have anal squamous cell carcinoma or lung adenocarcinoma, indicating that survival in these groups is comparable with that of non-infected patients.

The first report, published in JAMA Oncology, investigated the impact of HIV status among 833 US veterans with stage I–III anal squamous carcinoma who were treated with definitive chemoradiotherapy between 2000 and 2015.

The 18.0% of patients who tested positive for the virus were more likely than their HIV-negative counterparts to be younger, male and Black but tumour stage, treatment and comorbidity did not differ between the groups. Most (91.0%) HIV-positive patients had received highly active antiretroviral therapy in the 6 months before treatment for cancer.

HIV-positive patients were as likely as HIV-negative patients to miss a second cycle of chemotherapy overall, but were significantly more likely to miss their second mitomycin C cycle (odds ratio [OR]=2.03) and require a radiotherapy break of at least 5 days (OR=1.66) but not a break of 10 days or longer.

HIV-positive patients were also more likely to develop grade 3–4 haematological adverse events (OR=2.18) and be admitted to hospital within 90 days of treatment for acute side effects (OR=1.75); this was especially true for haematological events (OR=2.20) but was not seen for gastrointestinal toxicity.

However, these differences in toxicity did not impact the long-term risk of ostomy between HIV-positive and -negative patients, or affect cancer-specific mortality or all-cause mortality.

“These data point to the need to optimize treatment in this population to decrease or better manage acute toxic effects”, write James Murphy, from the University of California, San Diego, USA, and co-authors.

“Our results also paint an optimistic picture of the long-term prognosis for HIV-positive patients, reflecting the improvements in HIV disease control and supportive care for this vulnerable population.”

The second study investigated the impact of epidermal growth factor receptor (EGFR)and KRAS mutations in 55 patients with HIV infection and lung adenocarcinoma and 136 HIV-negative lung adenocarcinoma patients matched by age, sex, race and smoking status.

As reported in the British Journal of Cancer, EGFR mutations were identified in a similar proportion of HIV-positive and -negative patients (7 vs 11%), as were KRAS mutations (22 vs 35%).

And overall survival (OS) did not differ significantly with HIV infection, regardless of EGFR or KRAS status, report Keith Sigel, from Icahn School of Medicine at Mount Sinai, New York, USA, and co-authors.

“These results suggest that mutational testing of lung adenocarcinomas should not vary based on HIV status”, they therefore recommend.

Noting that earlier antiretroviral therapy era study findings had found poorer OS with HIV infection, the researchers add: “Our HIV[-positive] cancer cases were relatively recently collected, which may explain the similarities in OS and lack of treatment disparities due to improved HIV disease management and increased comfort with managing lung cancer in this population by oncologists and surgeons, particularly in academic centres.”

References

Bryant AK, Huynh-Le M-P, Simpson DR, et al. Association of HIV status with outcomes of anal squamous cell carcinoma in the era of highly active antiretroviral therapy. JAMA Oncol; Advance online publication 21 September 2017. doi:10.1001/jamaoncol.2017.2844

Thaler J, Sigel C, Beasley MB, et al. Clinically significant mutations in HIV-infected patients with lung adenocarcinoma. Br J Cancer; Advance online publication 21 September 2017. doi: 10.1038/bjc.2017.333

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