Immune checkpoint inhibitors ‘safe and effective’ for people living with HIV, cancer
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Key takeaways:
- Among those with NSCLC, 20% with HIV and 22% without HIV experienced immune-related adverse events.
- Use of immune checkpoint inhibitors appeared safe and effective even among those on antiretroviral therapies.
People living with HIV and various cancer types may be safely treated with immune checkpoint inhibitors, according to results of a retrospective study published in Journal of Clinical Oncology.
The findings showed differential activity of immune checkpoint inhibitors across tumor types, and similar safety and efficacy among matched cohorts of those with and without HIV and metastatic non-small cell lung cancer.
Rationale and methods
People living with HIV have long been excluded from or had limited participation in clinical trials of immune checkpoint inhibitors due to safety and efficacy concerns stemming from their potentially dysfunctional immune systems, according to a Dana-Farber Cancer Institute press release.
Talal El Zarif, MD, research fellow in oncology in the department of medicine at Dana-Farber, and colleagues sought to evaluate the use of immune checkpoint inhibitor therapy among 390 people living with HIV (median age, 58 years; 85% men; 36% Black). Among them, 28% had NSCLC, 11% had hepatocellular carcinoma and 10% had head and neck squamous cell carcinoma. More than two-thirds of patients (70%) received anti-PD-1/PD-L1 monotherapy.
Among those with available baseline data, 70% (n = 152 of 216) had CD4+ T cell counts of 200 cells/µL or greater, and 94% (n = 179 of 190) had a HIV viral load of less than 400 copies/mL.
Researchers built the international and multi-institutional consortium Cancer Therapy Using Checkpoint Inhibitors in People Living with HIV-International (CATCH-IT). They used Kaplan-Meier methods to estimate OS and PFS, and measured objective response rates per RECIST 1.1 or other tumor-specific criteria.
Researchers additionally used restricted mean survival time to compare OS and PFS between matched people with HIV and people without HIV with metastatic NSCLC.
Findings
Results showed that 20% of all patients experienced any-grade immune-related adverse events and 7.7% experienced grade 3 or higher immune-related adverse events.
Researchers observed ORRs of 69% among patients with nonmelanoma skin cancer, 31% among those with NSCLC, 16% among those with HCC and 11% among those with head and neck squamous cell carcinoma.
Results of the matched metastatic NSCLC cohort showed that 12 of the 61 patients with HIV (20%) and 24 of the 110 patients without HIV (22%) experienced immune-related adverse events.
Researchers reported an adjusted 42-month restricted mean survival time difference of 0.06 months (95% CI, 5.49 to 5.37) for PFS and 2.23 months (95% CI, –4.02 to 8.48) for OS, neither of which achieved statistical significance.
Implications
The findings should “reassure physicians that the use of immune checkpoint inhibitors is safe and effective in this patient population, even for those on antiretroviral therapy,” researchers concluded.
“Overall, the authors believe that this effort represents a stepping-stone that will motivate further studies involving patients living with HIV and cancer and better inform treatment decisions for this unique population,” the press release stated.
References:
- Dana-Farber researchers report on the safety and activity of immune checkpoint inhibitors in people living with HIV and cancer (press release). Available at: https://www.dana-farber.org/newsroom/news-releases/2023/dana-farber-researchers-report-on-the-safety-and-activity-of-immune-checkpoint-inhibitors-in-people-living-with-hiv-and-cancer/.. Published May 16, 2023. Accessed June 23, 2023.
- El Zarif T, et al. J Clin Oncol. 2023;doi:10.1200/JCO.22.02459.
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