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Lung Cancer Chemotherapy Less Frequent With HIV, But Toxicity No Greater
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IDWeek 2018, October 3-7, 2018, San Francisco
Mark Mascolini
Comparison of HIV-positive and negative people with lung cancer found less frequent chemotherapy in the HIV group, although chemo side effects did not differ significantly between treated people with and without HIV [1]. Age, sex, histologic subtype, and cancer stage were similar in these HIV-positive and negative people with lung cancer diagnosed in the past 10 years.
HIV infection confers a heightened risk of lung cancer. Because HIV populations are surviving longer yet continue to smoke more than the general population, lung cancer has become a major cause of death in people with HIV. Yet little is known about lung cancer treatment rates and tolerability in HIV-positive versus negative people. Some prior research indicates higher treatment complication rates with than without HIV [2,3]. But a recent comparison of lung cancer resection outcomes in 151 veterans with HIV and 273 veterans without HIV found no difference in complication frequency or 30-day mortality [4].
The new analysis by researchers at New York's Mount Sinai Beth Israel compared 84 HIV-positive people with 48 HIV-negative people matched by age, sex, and lung cancer stage. Everyone got diagnosed with lung cancer between 2006 and 2017--the most recent antiretroviral decade. The Mount Sinai team used electronic medical records to collect demographic and clinical data and details of lung cancer treatment and adverse outcomes.
The HIV-positive and negative groups were similar in age (57.5 and 58.5 years), proportion of men (57% and 60%), and proportions of current smokers (33% and 23%) and former smokers (51% and 50%) (P = 0.1) . The HIV group included a lower proportion of whites (19% versus 33%) and higher proportions of blacks (49% versus 21%) and Hispanics (20% versus 15%) (P = 0.001). The HIV contingent had higher proportions with chronic kidney disease (13% versus 0, P = 0.007), HCV infection (39% versus 10%, P = 0.001), and a drug use history (33% versus 2%, P = 0.001).
People with HIV did not differ substantially from HIV-negative comparators in histologic subtype of lung cancer (75% and 73% adenocarcinoma) or lung cancer stage (24% and 23% stage IA or IB, 39% and 48% stage IV). Among people with lung cancer stages I through IIIA, 65% with HIV and 78% without HIV had surgery, a nonsignificant difference (P = 0.4). Overall 37% with HIV and 48% without HIV underwent surgery, also a nonsignificant difference (P = 0.3). Among people with stage I lung cancer, 8% with HIV and none without HIV had radiosurgery (P = 0.048).
A significantly lower proportion of people with HIV received chemotherapy (44% versus 62%, P = 0.048). Of 14 chemotherapy adverse events assessed, none were significantly more or less frequent in the HIV group. Three adverse events proved nonsignificantly more frequent with HIV: early chemotherapy termination (44% versus 23%, P = 0.1), fever (11% versus 0, P = 0.1), and dehydration (11% versus 0, P = 0.1).
The researchers did not compare survival after lung cancer therapy by HIV status. They concluded that in the recent antiretroviral era there are limited lung cancer treatment disparities between people with and without HIV and "no major differences in chemotherapy toxicity associated with HIV status." The Mount Sinai investigators called for future work addressing barriers to optimal lung cancer care in people with HIV.
References
1. Kobayashi T, Stone K, Sigel K. Characteristics of lung cancer treatment in recent ART-era HIV+ patients. IDWeek 2018, October 3-7, 2018, San Francisco. Abstract 2240. Poster at https://idsa.confex.com/idsa/2018/webprogram/Paper71213.html
2. Sigel K, Pitts R, Crothers K. Lung malignancies in HIV infection. Semin Respir Crit Care Med. 2016;37:267-276.
3. Hooker CM, Meguid RA, Hulbert A, et al. Human immunodeficiency virus infection as a prognostic factor in surgical patients with non-small cell lung cancer. Ann Thorac Surg. 2012;93:405-412.
4. Sigel S, Park L, Kong J, et al. Short-term outcomes for lung cancer resection surgery in HIV infection. 16th International Conference on Malignancies in HIV/AIDS. October 23-24, 2017. Bethesda, Maryland. Abstract 67.
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