Non-AIDS-defining cancers more common in people with HIV on HAART
In the era of Highly Active Antiretroviral Therapy (HAART), majority of the malignancies in AIDS patients are non-AIDS-defining cancers (NADC), according to an India study presented at the recently concluded European Society for Medical Oncology Asia 2018 Congress (ESMO Asia 2018).
“In the [HAART] era, there is increased longevity of [HIV] patients which confers a higher lifetime risk of developing cancer,” said researchers.
The present retrospective review included 44 patients (mean age 42 years; 27 males) who were positive for HIV and had cancer, in whom survival outcomes were analysed using Kaplan-Meier curves. All participants were receiving antiretroviral therapy.
Of the 44 participants, 72 percent (n=32) were diagnosed with NADC, while the remaining 28 percent (n=12) had AIDS-defining cancers. The mean time to cancer development after HIV diagnosis was 5.4 years. Almost a third of the patients (29.5 percent) had poor general condition, with Performance Status scores of 3 or 4 on the Eastern Cooperative Oncology Group scale. [ESMO Asia 2018, abstract 404P]
Non-Hodgkin’s lymphoma (NHL) was the most common malignancy, being diagnosed in 32 percent (n=14) of the patients. In this subset, more patients had extranodal vs nodal presentations (79 percent vs 21 percent) and most presented with stage 1 disease. Eight of them showed B symptoms. The most common subtype was plasmablastic lymphoma.
Half of the NHL subgroup were given chemotherapy, which led to better outcomes than supportive care. “In the HIV-associated lymphoma patients, chemotherapy provides a response rate of 50 percent and achieves a median survival of 6 months as compared to only 1.5 months in those treated with supportive care,” said researchers
Chemotherapy regimens included CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone), R-CHOP (CHOP with monoclonal antibody rituximab) and CVP (cyclophosphamide, vincristine, prednisone).
In terms of solid tumours, cancers of the head and neck were the most common, diagnosed in 11 percent (n=5) of the participants. This was followed by cervical and penile carcinomas, each diagnosed in four patients. There were two patients each for colorectal carcinoma, appendicular mucinous neoplasm, breast carcinoma and anal canal carcinoma.
In this group of HIV patients (n=30), 14 patients underwent chemotherapy, with one achieving complete response and five showing partial response. The median survival was longer in those who received chemotherapy vs supportive care (7 vs 2 months).
“Majority of solid tumour patients present with stage 4 disease,” researchers noted. “Standard chemotherapy in the HIV-associated solid tumours achieves a response rate of 46 percent.”
For the present study, patient records were obtained from the Department of Medical Oncology, Madras Medical College, Chennai. Among the information collected were pathology reports, treatment details and CD4 counts, along with baseline demographic factors. Those who received care from January 2014 to June 2018 were eligible for inclusion.