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Immunotherapy in Patients With HIV Infection and Advanced Cancer

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Key Points

  • Checkpoint inhibitors offered similar objective response rates in treating non–small cell lung cancer (30%) and melanoma (27%) as has been found in patients with cancer without HIV.
  • The inhibitor offered benefit in treatment of Kaposi’s sarcoma, a cancer strongly linked to HIV infection for which there are not many effective treatment options.
  • Patients with HIV did not experience increased side effects, and HIV remained undetectable in 93% of patients (26 of 28) known to have undetectable viral load before treatment.

A study published by Cook et al in JAMA Oncology focused on whether treatment with checkpoint inhibitors is both safe and effective in patients with advanced cancer who are also human immunodeficiency virus (HIV)-positive. Because checkpoint inhibitors manipulate the immune system, the concern has been that these therapies might have adverse effects such as virus reactivation in patients with HIV infection.

Investigators searched the medical literature to find 73 patients with HIV whose cancer had been treated with checkpoint inhibitors. Only a fraction of patients came from a clinical trial; the rest were mostly case reports and case series from oncologists who chose to treat their patients with cancer and HIV infection with checkpoint inhibitors.

“[Patients with cancer and] HIV and their oncologists have found themselves in a real conundrum,” said the study’s lead investigator, Chul Kim, MD, MPH, Assistant Professor at Georgetown Lombardi Comprehensive Cancer Center and an attending physician at MedStar Georgetown University Hospital and MedStar Washington Hospital Center. “Because of their HIV infection, they are at higher risk of developing cancer than people who are not infected. In fact, cancer has become one of the leading causes of death in patients with HIV. But conventional chemotherapies can reverse HIV suppression, and on top of that, these patients are widely excluded from clinical studies that test the next generation of cancer treatments.”

Dr. Kim continued, “We hope our finding will lead to increased study of checkpoint inhibitors in patients with HIV and cancer,” adding that the checkpoint inhibitors might not just keep cancer in check. “There are signals in this analysis and other studies that suggest these new cancer drugs may restore an immune response against HIV in patients whose immune system is exhausted by its long fight with HIV.”

Findings

The researchers specifically found that checkpoint inhibitors offered similar objective response rates in treating non–small cell lung cancer (30%) and melanoma (27%) as has been found in patients with cancer without HIV. Additionally, the inhibitor offered benefit in treatment of Kaposi’s sarcoma, a cancer strongly linked to HIV infection for which there are not many effective treatment options. The objective response in this patient population was 67%.

Additionally, patients with HIV did not experience increased side effects, and HIV remained undetectable in 93% of patients (26 of 28) known to have undetectable viral load before treatment. “And we found something that is really intriguing,” Dr. Kim added. “In six patients who had a detectable load of HIV in the blood before treatment, five had a decrease in their viral load after treatment. It could be that checkpoint inhibitors are helping to suppress HIV, though this finding needs to be verified in future studies.”

To further investigate these findings, Georgetown will soon launch a clinical trial to test checkpoint inhibitor therapy as first-line therapy in patients with lung cancer and either HIV or viral hepatitis. “We will be able to look at what effects checkpoint inhibitor therapy has on both the cancer and the infection,” Dr. Kim concluded.

Disclosure: This study was supported by a Norman Rales Young Investigator Award from the ASCO Conquer Cancer Foundation and a Stanley and Linda Sher research grant from Georgetown University. The study authors' full disclosures can be found at jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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