Immunotherapy Is Safe for Patients With Cancer Living With HIV

Patients with HIV are living longer, which, coupled with their compromised immune systems, leaves the patient population more vulnerable to certain cancers. And while the development and uptake of antiretroviral therapy has reduced the risk of certain cancers, such as cervical cancer, that were previously prevalent in that population, a question remains for those who do receive a cancer diagnosis: Is immunotherapy, which targets the very system affected by HIV, safe in these patients?

Because patients with HIV have traditionally been excluded from clinical trials, their responses to new therapies, including immunotherapy, are not immediately known. However, according to a study presented at the ESMO 2018 Congress in Munich, Germany, treatment with PD-1 or PD-L1 inhibitors is a feasible option for patients who have cancer and are living with HIV.

“The point of this study was to look at an HIV-positive patient cohort with immunotherapy in conjunction with a close monitoring of their viral load and CD4 lymphocyte count,” explained Aurélien Gobert, of Groupe Hospitalier Pitié Salpêtrière in Paris, France, in a statement.

The study assessed nivolumab in 20 patients with HIV. In addition to viral load and CD4 lymphocyte count, tolerance and efficacy were studied. Of the patients, 1 had metastatic melanoma, and the remaining patients had metastatic non—small cell lung cancer. The median lymphocyte count at diagnosis was 338.5/mm³, and viral load was undetectable in 17 patients, low in 2 cases, and unknown in 1 case.

Patients were followed for 11 months, and by the end of the study period, the median number of nivolumab infusions was 6.

“We didn’t see any toxic deaths or immune-related adverse events,” said Gobert. “One patient did experience a rising HIV viral load and decreasing CD4 lymphocyte count, indicating a reactivation of the virus, but this occurred following the interruption of his antiretroviral therapy.”

The researchers were able to assess response in 17 patients, of whom 4 demonstrated a partial response and 2 had stable disease. The majority (n = 11) had disease progression at first evaluation.

Gobert cautioned that the cohort size and the length of follow-up did not allow the researchers to draw conclusions on the efficacy of the treatment. But, he said, they were able to determine that the treatment appeared to be well-tolerated by the patients, so long as antiretroviral therapy was continued.

“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,” said Gobert. “Going forward, this will need to be confirmed for various tumor types.”