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Immunotherapy Safe for Patients With HIV and Advanced Cancer

Kaposi sarcoma lesions.

Patients infected with HIV are at increased risk of cancer. For example, Kaposi sarcoma is 500 times more likely to occur in patients with HIV than in the general population. Because of their compromised immune systems, patients with HIV are not able to partake in immunotherapy clinical trials. However, researchers at Georgetown University have now found that immunotherapy is quite successful in treating patients with HIV and advanced-stage cancers, producing side effects in only a slight percentage of patients.

For the study, published in JAMA Oncology, the researchers compiled data collected from case studies, clinical trials, and medical literature on patients with HIV and advanced-stage cancers treated with checkpoint inhibitors. Of 70 patients, including 62 treated with anti-programmed cell death 1 (anti–PD-1) therapy, 6 treated with anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4) therapy, 4 treated with anti–PD-1/CTLA-4 combination therapy, and 1 treated with sequential anti–CTLA-4/PD-1 therapy, grade 3 or higher immune-related adverse events only occurred in 6 patients. The objective response rates for non-small cell lung cancer, melanoma, and Kaposi sarcoma were 30%, 27%, and 63%, respectively.

"Cancer patients with HIV and their oncologists have found themselves in a real conundrum," remarked the study's senior investigator, Chul Kim, MD, MPH, Assistant Professor at Georgetown Lombardi Comprehensive Cancer Center and 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. We hope our finding will lead to increased study of checkpoint inhibitors in patients with HIV and cancer."

For More Information

Cook MR & Kim C (2019). Safety and efficacy of immune checkpoint inhibitor therapy in patients with HIV infection and advanced-stage cancer. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2018.6737

Image courtesy of National Cancer Institute 

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