Most HIV patients have a 60% risk of developing a form of cancer during their life-span.
Cancers like Lymphoma, Lung Cancer, Anal Cancer, Cervical Cancer, Oral and oropharyngeal cancer ,liver cancer, skin cancer and also Kaposi's sarcoma are most prevalent among HIV patients.
At the recent ASCO presentation, study led by doctors at Fred Hutchinson Cancer Research Center showed that patients living with HIV and one of a variety of potentially deadly cancers could be safely treated with the immunotherapy drug pembrolizumab, also known by its brand name, Keytruda.
Lead author Dr. Tom Uldrick said that in almost all cases it was safe to use keytruda in patients with HIV and cancer. The "adverse events profile," a measure of the safety of the drug in the study, was not different from prior studies that excluded such patients. The results, study authors said, are likely applicable to five similar drugs that block receptors known as PD-1 or PD-L1 on the surface T cells.
"The results from the study conclusion is that anti-PD-1 therapy is appropriate for cancer patients with well-controlled HIV, and that patients with HIV and cancer can be treated with the drug and should be included in future immunotherapy studies," Uldrick said in an interview with correspondents from Thailand Medical News.
The trial studied only Keytruda (pembrolizumab), the anti-PD-1 therapy manufactured by Merck, who provided the study drug to the National Cancer Institute (NCI), which sponsored the trial. HIV-positive patients with different cancers that might respond to the drug were included in the trial. Among the cancers treated were lung cancer; Kaposi sarcoma, or KS; non-Hodgkin lymphoma; liver cancer; anal cancer and advanced squamous cell skin cancer.
The safety profile of pembrolizumab in people with HIV and cancer was similar to that noted in clinical trials in the general population. The study also provided a snapshot of the anti-cancer activity of the drug on HIV patients. One patient with lung cancer had a complete response to treatment, and activity was also noted in important HIV-associated cancers, including non-Hodgkin lymphoma, Kaposi sarcoma and liver cancer.
The researchers concluded that anti-PD-1 therapy be considered for FDA approved indications in patients with HIV who are on antiretroviral therapy and have a CD4 count above a certain threshold (100 cells per microliter of blood.)
The FDA and the American Society of Clinical Oncology have all recommended that HIV patients should be included in more clinical trials. The NCI has generally allowed patients with HIV to enroll on the immuno-oncology studies that it sponsors with PD-1 and PD-L1 inhibitors for cancer.However, this trial was one of only two trials sponsored by the NCI to focus exclusively on patients with HIV, and it has been the first trial to report its positive results.
Reference:Thomas S. Uldrick, Priscila H. Gonçalves, Maher Abdul-Hay, Alisa J. Claeys, Brinda Emu, Marc S. Ernstoff, Steven P. Fling, Lawrence Fong, Judith C. Kaiser, Andreanne M. Lacroix, Steve Y. Lee, Lisa M. Lundgren, Kathryn Lurain, Christopher H. Parsons, Sharavi Peeramsetti, Ramya Ramaswami, Elad Sharon, Mario Sznol, Chia-Ching (Jackie) Wang, Robert Yarchoan, Martin A. Cheever. Assessment of the Sa
fety of Pembrolizumab in Patients With HIV and Advanced Cancer—A Phase 1 Study. JAMA Oncology, 2019; DOI: 10.1001/jamaoncol.2019.2244