NCCN Releases Guidelines to Address Treatment Gaps for People With HIV and Cancer

People in the United States living with HIV have an approximately 50% increased rate of being diagnosed with cancer compared with the general population; however, these individuals are significantly less likely to be treated for cancer. To tackle the barriers people living with HIV face to accessing safe and necessary treatment, the National Comprehensive Cancer Center (NCCN) has released new NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines).

“The disparity in cancer care is large and significant,” Gita Suneja, MD, Duke Cancer Institute, co-chair of NCCN Guidelines Panel for Cancer in People Living With HIV, said in a statement. “For most cancers, people living with HIV are 2-to-3 times more likely to receive no cancer treatment compared to uninfected people.”

Although not all factors contributing to these large disparities in treatment have been identified, the lack of available clinical management guidelines for clinicians has proven to be a factor, according to Suneja.

The most common types of cancer that inflict people living with HIV are non-Hodgkin’s lymphoma, Kaposi sarcoma, lung cancer, anal cancer, prostate cancer, liver cancer, colorectal cancer, Hodgkin lymphoma, oral/pharyngeal cancer, female breast cancer, and cervical cancer.

The new NCCN Guidelines provide general advice, as well as specific treatment recommendations for non-small cell lung cancer, anal cancer, Hodgkin lymphoma, and cervical cancer, while simultaneously highlighting the importance of working with an HIV specialist.

“The ultimate goal is to improve cancer survival among people living with HIV,” said Suneja. “With modern antiretroviral therapy (ART), people with HIV are living longer and therefore getting more cancers related to both HIV infection and aging. The bottom line is that the cancer burden is growing—in fact, cancer is quickly becoming the leading cause of death in people living with HIV—so we urgently need to improve cancer treatment in this population.”

The guidelines urge that most people living with HIV who develop cancer should be offered the same cancer therapies as those without HIV, and the modification of cancer treatment should not be dependent on the basis of HIV status alone. With emphasis placed upon collaboration between an oncologist and HIV specialist, the guidelines recommend that the care team should review proposed cancer therapy and ART for possible drug—drug interactions and overlapping toxicity concerns prior to initiation of treatment.

“Some antiretroviral—cancer therapeutic combinations have serious risk of increased toxicity, while others may reduce levels of either cancer therapeutics or the antiretroviral,” said Erin Reid, MD, UC San Diego Moores Cancer Center, co-chair of the NCCN Guidelines Panel for Cancer in People Living With HIV and vice-chair of the AIDS Malignancy Consortium Lymphoma Working Group. “The good news is that with the expansion of antiretroviral combinations available, there is opportunity to minimize these risks by modifying antiretroviral therapy during cancer treatment.”

According to Reid, another major concern involves the risk of infectious complications, and the guidelines address infection prophylaxis considerations through specific recommendations for people living with HIV receiving therapy for whom significant immunosuppression/melosuppression is anticipated.