治疗 HIV 感染者的癌症。

Treating Cancer in People With HIV.

机构信息

HIV & AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.

出版信息

J Clin Oncol. 2023 Jul 20;41(21):3682-3688. doi: 10.1200/JCO.23.00737. Epub 2023 Jun 2.

Abstract

Journal Journal of Clinical Oncology.People with HIV (PWH) have an increased lifetime risk of developing certain cancers, even when HIV is well-controlled with antiretroviral therapy. Despite the tremendous advancements in HIV and cancer care over the past several decades, PWH have lower cancer-related survival compared with the general population. Treating HIV-associated cancers requires a multidisciplinary team to manage concurrent opportunistic infections, potential drug-drug interactions, and the co-occurrence of more than one cancer in the same patient. Many factors may lead PWH to receive inappropriate dose adjustments, exclusion from emerging therapies and clinical trials, or no cancer therapy at all. In general, PWH should receive the same standard, full-dose cancer therapy used in the general population unless there are data for specific cancer regimens in PWH. Agents targeting PD-1 and PD-L1 have US Food and Drug Administration (FDA)-approved indications in many HIV-associated cancers, including Hodgkin lymphoma, cervical cancer, head and neck cancer, hepatocellular carcinoma, and non-small-cell lung cancer; however, PWH were excluded from all clinical trials that led to FDA approval of these agents. Several prospective studies and an international retrospective study of PWH with advanced cancer have shown anti-PD-(L)-1 agents to be safe and effective across expected cancer types and CD4 T-cell counts, supporting their use in PWH for FDA-approved indications. Learning from the experience in anti-PD-(L)-1 agents, future cancer clinical trials should include and seek to actively enroll PWH, so that they have equal and timely access to emerging cancer therapies.

摘要

期刊《临床肿瘤学杂志》。即使艾滋病毒通过抗逆转录病毒疗法得到很好的控制,艾滋病毒感染者(PWH)仍会增加一生中罹患某些癌症的风险。尽管在过去几十年中,艾滋病毒和癌症治疗取得了巨大进展,但与普通人群相比,PWH 的癌症相关生存率仍然较低。治疗与艾滋病毒相关的癌症需要一个多学科团队来管理同时发生的机会性感染、潜在的药物相互作用,以及同一患者同时发生多种癌症的情况。许多因素可能导致 PWH 接受不适当的剂量调整、被排除在新兴治疗方法和临床试验之外,或者根本不接受癌症治疗。一般来说,除非针对特定的癌症方案有 PWH 的具体数据,否则 PWH 应接受与普通人群相同的标准、全剂量癌症治疗。针对 PD-1 和 PD-L1 的药物在美国食品和药物管理局(FDA)批准的许多与艾滋病毒相关的癌症中有适应症,包括霍奇金淋巴瘤、宫颈癌、头颈部癌症、肝细胞癌和非小细胞肺癌;然而,在导致这些药物获得 FDA 批准的所有临床试验中,都排除了 PWH。几项针对晚期癌症的 PWH 的前瞻性研究和一项国际回顾性研究表明,抗 PD-(L)-1 药物在预期的癌症类型和 CD4 T 细胞计数方面是安全有效的,支持其在 FDA 批准的适应症中用于 PWH。从抗 PD-(L)-1 药物的经验中吸取教训,未来的癌症临床试验应包括并寻求积极招募 PWH,以便他们能够平等、及时地获得新兴的癌症治疗方法。

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