Infectious Diseases Department, Gui de Chauliac Hospital, University of Montpellier 1, CHRU Montpellier, France.
J Thorac Oncol. 2010 Apr;5(4):562-71. doi: 10.1097/JTO.0b013e3181d3ccf2.
Interactions between combination antiretroviral therapy (CART) and lung cancer treatment are emerging clinical concerns. Among the reasons for that, one can observe the longer survival of human immunodeficiency virus (HIV)-infected patients since introduction of CART and the epidemiologic rising of lung cancer, mainly adenocarcinomas, in this population. In addition, the higher relative risk of lung cancer in HIV-infected patients compared with general population has been recently demonstrated. Patients' demography and disease characteristics differ from the general lung cancer population, although most cases occur in patients with a smoking history: HIV-infected subjects are generally younger and diagnosis frequently made at locally advanced or metastatic stages. The choice of cytotoxic chemotherapy and antiretroviral therapy is essential in the context of lung cancer (1) to minimize potential interactions and life-threatening toxicities particularly through cytochrome P450 interaction, (2) to implement adequate prevention of foreseeable toxicity, and (3) to fully reinforce antineoplastic and antiretroviral efficacy. Pharmacokinetics data and clinical cases pinpoint to potential life-threatening interactions between protease inhibitors/ritonavir and taxanes, vinca alkaloids, as well as the anilinoquinazolines erlotinib and gefitinib and irinotecan. Optimal choice of chemotherapy and CART in HIV-infected patients with lung cancer is an individualized multidisciplinary decision, involving clinical and antiretroviral history, and predicting potential adverse events and interactions.
联合抗逆转录病毒疗法（CART）与肺癌治疗之间的相互作用是新兴的临床关注点。原因之一是，自从引入 CART 以来，感染人类免疫缺陷病毒（HIV）的患者的生存时间延长，并且该人群中肺癌（主要是腺癌）的流行病学发病率上升。此外，与普通人群相比，HIV 感染患者患肺癌的相对风险更高。尽管大多数病例发生在有吸烟史的患者中，但患者的人口统计学和疾病特征与普通肺癌人群不同：HIV 感染患者通常更年轻，并且经常在局部晚期或转移性阶段被诊断出患有肺癌。在肺癌治疗中，选择细胞毒性化疗药物和抗逆转录病毒治疗至关重要（1）可以最大程度地减少潜在的相互作用和危及生命的毒性，特别是通过细胞色素 P450 相互作用；（2）可以充分预防可预见的毒性；（3）可以充分增强抗肿瘤和抗逆转录病毒的疗效。药代动力学数据和临床病例表明，蛋白酶抑制剂/利托那韦和紫杉烷类药物、长春花生物碱类药物以及苯胺喹唑啉类药物厄洛替尼和吉非替尼以及伊立替康之间存在潜在的危及生命的相互作用。患有肺癌的 HIV 感染患者中，最佳的化疗和 CART 选择是个体化的多学科决策，涉及临床和抗逆转录病毒病史，并预测潜在的不良事件和相互作用。
