Early Study Indicates Safety, Efficacy of Immunotherapy in Cancer Patients with HIV

Treatment with PD-1/PD-L-1 immune checkpoint inhibitors can be safe and feasible in patients with cancer who are treated for HIV, according to a new study presented at the European Society for Medical Oncology 2018 Congress.

The study evaluated patients with HIV who were treated with immunotherapy while closely monitoring their viral load and CD4 lymphocyte count. The researchers used cases presented in the multidisciplinary meetings of the national HIV network to assess the effects of the PD-1 inhibitor nivolumab in patients with HIV. They collected tolerance and efficacy information from patients treated with the drug, along with demographic data. The study population included mostly men around 60 years of age.

In total, 20 patients were evaluated, of whom 5% had metastatic melanoma and 95% had metastatic non-small cell lung cancer. Median lymphocyte count at diagnosis was 338.5/mm³ and viral load was undetectable in 17 patients, low in 2 patients, and unknown in 1 patient, according to the study. Median follow-up was approximately 11 months and the median number of nivolumab infusions received was 6 at the time of cut-off analysis.

According to the researchers, no toxic deaths or immune-related adverse events occurred. However, 1 patient did experience a rising HIV viral load and decreasing CD4 lymphocyte count, which occurred following the interruption of antiretroviral therapy. Overall, a partial response was observed in 4 patients, whereas 2 had stable disease and 11 had disease progression at the first evaluation.

“Although the response data is fairly consistent with results obtained with the same drug among other cancer patients, the size of our sample and the length of follow-up do not allow us to draw any conclusions regarding efficacy,” study author Aurélien Gobert of Groupe Hospitalier Pitié Salpêtrière in Paris, France, said in a statement.

According to Dr Gobert, the findings indicate that the treatment appears to be well tolerated in patients with HIV, as long as antiretroviral therapy is maintained. Larger studies will be needed to further confirm the efficacy of these treatments in this population.

“It speaks to the feasibility of immunotherapy in this patient population, which represents a significant proportion of cancer diagnoses, and among whom malignancies accounted for more than a third of deaths in 2010,” Dr Gobert added. “Going forward, this will need to be confirmed for various tumor types.”

Reference

Gobert et al. HIV and cancer: What's new in 2017? Bulletin du Cancer 2018; https://doi.org/10.1016/j.bulcan.2018.02.002

Immunotherapy is safe and feasible in cancer patients treated for HIV, study suggests [ESMO 2018 Press Release]. European Society for Medical Oncology’s website. https://www.esmo.org/Press-Office/Press-Releases/immunotherapy-cancer-HIV-Gobert. Accessed October 24, 2018.