Casado José L, Machuca Isabel, Bañón Sara, Moreno Ana, Moltó José, Rodriguez Miguel A
Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain.
Antivir Ther. 2015;20(7):773-7. doi: 10.3851/IMP2961. Epub 2015 Apr 16.
There are few data on the best combination antiretroviral therapy in patients with HIV infection who need cancer chemotherapy because of drug-drug interactions and increased risk of toxic effects.
We evaluated the safety, efficacy and interactions of a raltegravir (RAL)-based regimen in 30 HIV-infected patients who received antineoplastic agents.
A total of 17 patients had a non-AIDS-defining malignancy (7 with Hodgkin disease) and 13 had an HIV-related cancer (9 non-Hodgkin lymphoma, 2 Kaposi sarcoma and 2 anal cancer). Overall, they received 49 cycles of chemotherapy with 19 different antineoplastic drugs, including antimetabolites in 4 patients (5-FU, gemcitabine), alkylating agents in 10 cases (cyclophosphamide, ifosfamide), vinca alkaloids in 17 patients (vincristine, vinblastine), anti-tumour antibiotics in 18 cases (doxorubicin), cisplatin or carboplatin in 6, and monoclonal antibodies in 13 patients (rituximab, trastuzumab, cetuximab). Six patients modified the doses of antineoplastic agents due to toxicity not related to raltegravir. During a median follow-up of 67.8 patient-years (median 170 days in concomitant therapy) there was only 1 case of virological failure and no patient discontinued RAL. Geometric mean trough levels of RAL were 143 ng/ml (79-455). There were no opportunistic infections, median CD4(+) T-cell count increased by 49 cells/ml and four (13%) patients died during the study (not related to AIDS progression).
Our results show that a RAL-based regimen is safe and effective in patients requiring chemotherapy, irrespective of type and of duration of chemotherapy.
关于因药物相互作用及毒性作用风险增加而需要进行癌症化疗的HIV感染患者最佳联合抗逆转录病毒治疗的数据较少。
我们评估了30例接受抗肿瘤药物治疗的HIV感染患者中基于raltegravir（RAL）方案的安全性、疗效及相互作用。
共有17例患者患有非艾滋病定义的恶性肿瘤（7例霍奇金病），13例患有与HIV相关的癌症（9例非霍奇金淋巴瘤、2例卡波西肉瘤和2例肛门癌）。总体而言，他们接受了49个周期的化疗，使用了19种不同的抗肿瘤药物，包括4例患者使用抗代谢药物（5-氟尿嘧啶、吉西他滨），10例使用烷化剂（环磷酰胺、异环磷酰胺），17例使用长春花生物碱（长春新碱、长春碱），18例使用抗肿瘤抗生素（多柔比星），6例使用顺铂或卡铂，13例使用单克隆抗体（利妥昔单抗、曲妥珠单抗、西妥昔单抗）。6例患者因与raltegravir无关的毒性反应而调整了抗肿瘤药物剂量。在中位随访67.8患者年期间（联合治疗中位时间为170天），仅有1例病毒学失败，无患者停用RAL。RAL的几何平均谷浓度为143 ng/ml（79 - 455）。无机会性感染，中位CD4(+) T细胞计数增加了49个细胞/ml，4例（13%）患者在研究期间死亡（与艾滋病进展无关）。
我们的结果表明，基于RAL的方案在需要化疗的患者中是安全有效的，无论化疗类型和持续时间如何。
