Immune checkpoint inhibitors viable in advanced cancer complicated by HIV
medwireNews: Immune checkpoint inhibitor (ICI) therapy is well tolerated by patients with HIV infection and advanced-stage cancer and does not appear to adversely affect HIV viral load or CD4 cell count, suggest results of a systematic data review.
Furthermore, objective response rates to US Food and Drug Administration-approved ICIs (ipilimumab, nivolumab, pembrolizumab, avelumab, atezolizumab, and durvalumab) ranged from 27% for patients with melanoma, to 30% for those with non-small-cell lung cancer (NSCLC), and 63% for those with Kaposi sarcoma.
The review, conducted by Michael Cook and Chul Kim, both from Georgetown University in Washington, DC, USA, included data on 73 individuals (mean age 56 years, 90% men) from 11 case reports, four meeting abstracts, and two case series.
Among them, 34.2% had NSCLC, 21.9% had melanoma, 12.3% had Kaposi sarcoma, 6.8% had anal cancer, 5.5% had head and neck cancer, and 19.2% had other cancers.
Treatments included anti-programmed cell death protein 1 (PD-1) therapy (84.9%), anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4) therapy (8.2%), anti-PD-1/anti-CTLA-4 combination therapy (5.5%), and sequential ipilimumab and nivolumab therapy (1.4%).
The majority (94.5%) of the patients were receiving antiretroviral therapy when they began treatment with an ICI.
The researchers report in JAMA Oncology that “immune checkpoint inhibitor therapy was generally well tolerated,” with six of 70 patients experiencing grade 3 or higher immune-related adverse events, including two cases of colitis and one case each of insulin-dependent diabetes, myositis, hepatitis, and lymphopenia. Three of these cases were associated with combined ipilimumab plus nivolumab use, two with nivolumab, and one with ipilimumab.
The higher rate of grade 3 or higher immune-related adverse events among patients receiving combination therapy is “consistent with the findings from other studies in patients without HIV infection,” Cook and Kim note.
Two of 28 patients with an undetectable viral load at baseline had detectable virus following treatment, while five of six with detectable virus at baseline had a decrease in viral load, to undetectable levels in four cases, following ICI therapy.
In addition, mean CD4 cell count increased by an average of 12.3 cells/μL following treatment, with 14 of 25 patients experiencing an increase and 11 experiencing a decrease after treatment initiation.
“Based on the results of the present systematic review and in the absence of definitive prospective data suggesting an unfavorable risk to benefit ratio, ICI therapy may be considered as a viable treatment option for HIV-infected patients with advanced cancer,” Cook and Kim conclude.
They add: “Several ongoing clinical trials are examining the use of nivolumab, durvalumab, pembrolizumab, and the combination of ipilimumab with nivolumab in a variety of tumor types among patients with HIV infection. The results of these trials will shed further light on the safety and efficacy of ICI therapy in patients with HIV infection.”
By Laura Cowen
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