Standard Therapy for Anal Cancer May Not Affect Long-term Outcomes Among HIV Patients

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Healthy HIV-positive patients with anal cancer are treated with standard chemoradiotherapy, but whether this patient population experiences worse outcomes or more severe toxic effects was previously u
Healthy HIV-positive patients with anal cancer are treated with standard chemoradiotherapy, but whether this patient population experiences worse outcomes or more severe toxic effects was previously u

Patients with anal cancer who are HIV-positive may experience more acute treatment-related toxicities from standard therapy compared with HIV-negative patients, but may not be affected in long-term outcomes, according to a study published in JAMA Oncology.1

Healthy HIV-positive patients with anal cancer are treated with the recommended standard of fluorouracil and mitomycin C concurrent chemoradiotherapy, but whether this patient population experiences worse outcomes or more severe toxic effects is unknown.

For this study, researchers enrolled 833 patients with stage I to III anal squamous cell carcinoma who previously received chemoradiotherapy, of which 150 were HIV-positive and 683 were HIV-negative. Patients with positive HIV status were more likely to be male, younger, and African American (P < .001). Around 90% of patients had received highly active antiretroviral therapy within 6 months prior to cancer therapy.

Patients in both study arms were as likely as the other to miss a second cycle of chemotherapy (odds ratio [OR], 1.28; 95% CI, 0.77-2.47; P = .27), but patients who were HIV-positive had higher rates of missing the second cycle of mitomycin C (OR, 2.03; 95% CI, 1.20-3.44; P = .008).

Forty-six percent and 33% of patients experienced radiotherapy treatment breaks of 5 days or more in the HIV-positive and HIV-negative arms, respectively (OR, 1.66; 95% CI, 1.07-2.56; P = .02), but there were no differences in breaks of 10 days or more.

Patients with HIV had a higher frequency of hospitalization within 90 days of treatment for acute adverse events (AEs; OR, 1.75; 95% CI, 1.16-2.66; P =.008), particularly for hematologic AEs (OR, 2.20; 95% CI, 1.33-3.64; P = .002), but not for gastrointestinal effects (OR, 1.35; 95% CI, 0.75-2.44; P =.32). Grade 3 to 4 hematologic AEs were experienced at a higher rate in patients that were HIV-positive compared with those who were HIV-negative (OR, 2.18; 95% CI, 1.45-3.28; P < .001).

Patients with HIV had a higher non-cancer-related mortality, but there were no differences in all-cause or cancer-specific mortality compared with HIV-negative patients.

The authors concluded that “these data point to the need to optimize treatment in this population to decrease or better manage acute toxic effects. Our results also paint an optimistic picture of the long-term prognosis for HIV-positive patients, reflecting the improvements in HIV disease control and supportive care for this vulnerable population.”

Reference

  1. Bryant AK, Huynh-Le MP, Simpson DR, Gupta S, Sharabi AB, Murphy JD. Association of HIV status with outcomes of anal squamous cell carcinoma in the era of highly active antiretroviral therapy. JAMA Oncol. 2017 Sep 21. doi: 10.1001/jamaoncol.2017.2844 [Epub ahead of print]

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