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INSTIs appear best for HIV patients with cancer
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DENVER — Integrase strand transfer inhibitors appear to be the preferred antiretroviral agent for HIV patients receiving chemotherapy, researchers reported here at the 2013 Interscience Conference on Antimicrobial Agents and Chemotherapy.
“This is the largest reported analysis studying different antiretroviral regimens in HIV-infected cancer patients,” Harrys Torres, MD, of The University of Texas MD Anderson Cancer Center, told Infectious Disease News. “Combinations that included protease inhibitors were the least favorable. On the other hand, non-nucleoside reverse transcriptase inhibitors and integrase strand transfer inhibitors had comparable efficacy.”
Harrys Torres
Torres and colleagues evaluated 134 patients with HIV and any type of cancer who were treated from 2001 to 2011. All patients received optimized background therapy plus either protease inhibitors, non-nucleoside reverse transcriptase inhibitors (NNRTIs) integrase strand transfer inhibitors (INSTIs) or other treatment. A team of oncologists, pharmacists and infectious disease specialists evaluated regimens for drug-drug interactions.
The most common malignancies were hematologic (60%), and most of those were non-Hodgkin’s lymphoma. Besides optimized background therapy, 40% of patients received protease inhibitors, 34% received NNRTIs, 17% received INSTIs and 11% received other treatments. The researchers defined efficacy as absence of virologic failure for more than 6 months or virologic rebound.
At 6 months, efficacy was similar between the patients who received INSTIs (100%) and those who received NNRTIs (96%), and both were superior to protease inhibitor-based regimens (62%). Adverse effects were more common with protease inhibitors, and clinically relevant interactions were only seen in patients receiving protease inhibitors.
“Based on its safety, INSTIs appeared to be the antiretroviral of choice for cancer patients receiving various chemotherapeutic agents and those with hematologic malignancies,” Torres said. “Of note, raltegravir (Isentress, Merck) was the only INSTI available during the study period. Prospective studies are now required to further define the toxicity profiles and efficacy of antiretrovirals, including newer agents in HIV-infected cancer patients receiving chemotherapy.”
For more information:
Torres H. #H-1255. Presented at: ICAAC 2013; Sept. 10-13; Denver.
Disclosure: Torres serves as a consultant for Astellas, Merck & Co., Novartis, Pfizer and Vertex Pharmaceuticals.