Moreover, recommendations for immunovirological monitoring have been published.
The CANCERVIH working group 7 has recommended that all new cases of PLWHIV with cancer should be included in the CANCERVIH database and discussed during the bimonthly national multidisciplinary board. 6 Here, we report five cases taken from the CANCERVIH database of PLWHIV with advanced NSCLC and treated with first-line pembrolizumab. A main objective of CANCERVIH is to ensure equal care for PLWHIV, particularly through access to therapeutic innovations including immunotherapy. The French CANCERVIH network is a multidisciplinary task force supported by the French National Cancer Institute (INCa) whose mission is to optimize management and care of PLWHIV suffering from cancer.
#Platinum notes 3 vs 4 trial#
4 The CHIVA 2 trial has recently addressed the possible use of immunotherapy as second-line treatment for PLWHIV with advanced NSCLC 5 however, safety and efficacy data on ICIs as first-line therapy are still lacking. Until recently, this population was rarely studied: only few cases in phase 1 and 2 clinical trials had described the use of ICIs as second or subsequent lines of treatment for PLWHIV with advanced NSCLC. Because ICIs act by suppressing immune tolerance and reactivating an effective immune response, major concerns in PLWHIV were as follows: (1) a lack of antitumoral response owing to HIV-related chronic immune deficiency and (2) the risk of anti-HIV response modulation and deregulation of immune parameters, potentially leading to immune reconstitution inflammatory syndrome (IRIS). In the past 5 years, immune checkpoint inhibitors (ICIs)-notably programmed cell death protein-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors-have become the standard of care for advanced NSCLC in the general population, initially as second-line 2 and then as first-line treatment in patients with greater than or equal to 50% tumor PD-L1 expression 3 and finally in combination with chemotherapy in all patients, except those with oncogene-driven NSCLC. 1 Because of a possible drug-to-drug interaction between chemotherapy and HAART, these patients require particular monitoring. Instead, non–AIDS-related cancers have become a leading cause of morbidity and mortality in people living with human immunodeficiency virus (PLWHIV), with NSCLC being the first cause of mortality. The use of highly active antiretroviral therapy (HAART) in developed countries has led to considerable reduction in mortality from acquired immunodeficiency syndrome (AIDS) caused by opportunistic infections and AIDS-defining cancers. Nevertheless, besides safety and drug-to-drug interactions, the effectiveness of first-line immunotherapy in people living with HIV needs to be supported by larger studies. We also evaluated the effectiveness of immunotherapy in these HIV-immunosuppressed patients: the average survival was 9.8 months, with three patients having rapid progression and two partial response. Moreover, pembrolizumab did not seem to modify HIV viral parameters. Our results are consistent with those of previous case reports concerning safety of immunotherapy in patients with HIV, revealing no severe or fatal toxicity, opportunistic infections, or immune reconstitution inflammatory syndrome. Here, we report the largest known study of patients with HIV with NSCLC (five patients) undergoing first-line immunotherapy by pembrolizumab, after CANCERVIH group selection.
Only few cases of patients with HIV suffering from cancer and undergoing first-line immunotherapy have been reported so far.
This particularly fragile population is frequently excluded from clinical trials, and up-to-date recommendations for these patients are lacking. In the recent past, we observed an increased risk of cancer in the population with human immunodeficiency virus (HIV) owing to the development of antiretroviral therapies that decreased mortality caused by HIV-specific infections.
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