Patients with human immunodeficiency virus (HIV) and non-small cell lung cancer (NSCLC) appear to have a poorer prognosis than patients without HIV even after accounting for confounding factors and competing risks of death, according to a new study presented March 4th at the 20th Conference on Retroviruses and Opportunistic Infections (CROI 2013). At this meeting, researchers reported NSCLC may exhibit more aggressive behavior in the setting of HIV infection.
“We found that patients with HIV, regardless of treatment or competing risks, did do worse with lung cancer than noninfected patients,” said lead study investigator Keith Sigel, MD, MPH, who is an assistant professor at Mount Sinai School of Medicine, New York, NY. “There are some data in the transplant population that shows patients with longstanding immunosuppression may have more aggressive tumor behavior. So, the question becomes, does T-cell impairment cause lung cancer to act more aggressively?”
Dr. Sigel, who presented the study findings at the meeting, said HIV-infected patients are at greater risk of developing lung cancer than the general population; however, he said it is unclear whether lung cancer prognosis is altered in patients who are HIV infected. Dr. Sigel and his colleagues performed a nested case-control study using the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare claims from 1996 to 2007. The researchers identified 267 HIV-infected patients with NSCLC and those cases then were matched by age, gender, race, and reason for Medicare entitlement to 1,208 patients with no evidence of HIV infection.
They found that cancer stage at presentation, and histology, did not differ by HIV status. Dr. Sigel said the majority (>57%) of both groups presented with stage IIIB-IV disease. However, overall survival (OS) in patients with HIV and NSCLC was significantly poorer—7 months—when compared to patients who were not HIV infected (OS, 25 months). This trend persisted, Dr. Sigel said, even after stratifying by cancer stage and use of stage-appropriate lung cancer treatment.
Using conditional probability function (CPF) analyses, the researchers found that HIV infection was associated with a greater risk of lung cancer death (odds ratio: 1.7; P<0.01) after adjustment for age, sex, race, income, cancer stage, use of stage-appropriate cancer therapy, nursing home residence, use of home services, marital status, and comorbidity score.
“These patients clearly need aggressive treatment. They have more aggressive cancer,” said Dr. Sigel in an interview with ChemotherapyAdvisor.com. “They seem to tolerate the lung cancer treatment well. As far as treatment, I think most oncologists would agree that patients with HIV should be treated exactly the same as patients without HIV, but keeping in mind issues concerning drug interactions.”