Immune checkpoint inhibitors have proven safety in cancer patients with HIV

In comparison to people living without HIV (PWOH), there is an exclusion of people living with HIV (PWH) and cancer from immune checkpoint inhibitor (ICI) trials. There remains a lack of real-world data on ICIs usage in PWH and cancer.

In the present study, researchers included PWH treated with anti–PD-1- or anti–PD-L1-based therapies for advanced cancers. They measured Objective response rates (ORRs) per RECIST 1.1 or other tumour-specific criteria whenever feasible.

The study results are:

• There were 390 PWH with a median age of 58, including 85% males.
• Two hundred seventy-four participants received anti–PD-1/anti–PD-L1 monotherapy.
• The most common cancers were NSCLC, hepatocellular carcinoma, and head and neck squamous cell carcinoma constituting 28%, 11% and 10 %.
• One hundred fifty-two participants constituting 70 %, had CD4+ T cell counts ≥200 cells/µL.
• 94% participants nearly 179 participants out of 190 had HIV viral load <400 copies/mL.
• Seventy-nine participants constituting 20 %, had any grade immune-related adverse events (irAEs).
• 30 participants out of 390, 7.7%, had grade ≥3 irAEs.
• ORRs were 69%, 31%, 16% and 11% for nonmelanoma skin cancer, NSCLC, HCC and HNSCC) respectively.
• Considering matched mNSCLC cohort (61 PWH v 110 PWOH), 20% PWH and 22% PWOH had grade immune-related adverse events or irAEs.
• The adjusted 42-month RMST difference was –0.06 months and 2.23 months for PFS and OS, respectively.

Concluding further, Among PWH, ICIs demonstrated differential activity across cancer types with no excess toxicity.

They said, “We reported similarities in Safety and activity of ICIs between matched cohorts of PWH and PWOH with mNSCLC.

They said there have been general concerns regarding ICIs safety in patients with cancer and HIV. The results of our study should reassure physicians that using ICIs is safe and effective even for those who are on ART.

ICIs were safe and had differential activity across types of tumour. Among PWH with non–small-cell lung cancer (NSCLC), CD4+ T-cell counts, or ART regimens did not influence treatment outcomes.

Further reading:

https://ascopubs.org/doi/full/10.1200/JCO.22.02459