EMBARGOED UNTIL: Thursday, September 12, 11:00 AM MDT
(Session 159, Paper H-1255)
UT MD Anderson Cancer Ctr., Houston, TX, United States
At 30 years into the human immunodeficiency virus (HIV) infection epidemic, the optimal antiretroviral (ARV) treatment in infected patients with cancer remains unknown. We therefore sought to retrospectively study HIV-infected cancer patients who received different ARV regimens, consisting of nucleoside reverse transcriptase inhibitors (NRTIs) plus 1) protease inhibitors (PIs), 2) non-NRTIs (NNRTIs), 3) integrase strand-transfer inhibitors (INSTIs), or 4) combinations of them. Raltegravir was the only available during the study period. We studied a total of 154 patients. Most of the patients were male (80%) and white (51%). The most common underlying malignancy was hematologic (n = 90 [58%]), primarily non-Hodgkin lymphoma (n = 64 [71%]). Among the 64 patients with solid tumors, most had gastrointestinal cancer (n = 20 [31%]). Nineteen patients (12%) underwent hematopoietic stem cell transplantation. Patients received NRTIs with PIs (37%), NNRTIs (32%), INSTIs (19%), or combinations of these regimens (11%). INSTIs were the most common ARVs used in patients with hematologic malignancies (P<.001) and in those receiving high-dose steroids or specific chemotherapeutic agents (topoisomerase inhibitors, alkylating agents, or antimetabolites). Side effects occurred in 35%, 14%, 3%, and 6% of patients receiving PIs, NNRTIs, INSTIs, and regimen combinations, respectively (P=.001). Multiple logistic regression analysis demonstrated that INSTIs and NNRTIs were six times (95% confidence interval, 1.1-39.6) and nine times (95% confidence interval, 1.6-56.2) more likely to be effective at 6 months, respectively, than PI regimens. This is the largest reported analysis of administration of different ARV regimens in HIV-infected cancer patients. Combinations that included PIs were the least favorable. NNRTIs and INSTIs had comparable efficacy, but based on its safety, INSTIs (raltegravir) appeared to be the ARVs of choice for HIV-infected patients with hematologic malignancies or those receiving various chemotherapeutic agents.
In collaboration with the co-authors listed above, Dr. Harrys A. Torres, an Assistant Professor of Medicine, designed and carried out this investigator-initiated study sponsored by Merck & Co., Inc. They conducted the study at The University of Texas MD Anderson Cancer Center and will present the results at the Interscience Conference on Antimicrobial Agents and Chemotherapy in Denver, CO, on September 11, 2013.
The need for concurrent treatment of cancer and HIV infection with antineoplastic agents and ARVs is increasing. Our preliminary results appear to be promising, providing for the first time clinically relevant information on ARV-based treatment in HIV-infected cancer patients receiving various chemotherapeutic agents. However, our results should be interpreted with caution given the study’s retrospective nature, and lack of pharmacokinetic assessment. Prospective studies are required to further define the toxicity profiles of HIV-infected cancer patients receiving chemotherapy. Such studies should aid the development of specific guidelines for treatment in this patient population.