Affordable Access

Access to the full text

Safety and efficacy of immune checkpoint inhibitors (ICIs) in cancer patients with HIV, hepatitis B, or hepatitis C viral infection

Authors
  • Shah, Neil J.1, 2
  • Al-Shbool, Ghassan3
  • Blackburn, Matthew4
  • Cook, Michael4
  • Belouali, Anas5
  • Liu, Stephen V.1
  • Madhavan, Subha5
  • He, Aiwu Ruth1
  • Atkins, Michael B.1
  • Gibney, Geoffrey T.1
  • Kim, Chul1
  • 1 Lombardi Comprehensive Cancer Center MedStar Georgetown University Hospital, 3800 Reservoir Rd. N.W., LCCC Bldg, 2nd FL, Pod B P413, Washington, DC, 20007, USA , Washington (United States)
  • 2 Memorial Sloan Kettering Cancer Center, Manhattan, New York City, USA , Manhattan (United States)
  • 3 MedStar Washington Hospital Center, Washington, DC, USA , Washington (United States)
  • 4 MedStar Georgetown University Hospital, Washington, DC, USA , Washington (United States)
  • 5 Georgetown University, Washington, DC, USA , Washington (United States)
Type
Published Article
Journal
Journal for ImmunoTherapy of Cancer
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Dec 17, 2019
Volume
7
Issue
1
Identifiers
DOI: 10.1186/s40425-019-0771-1
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundPatients with chronic viral infections including human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) are at increased risk of developing malignancies. The safety and efficacy of ICI therapy in patients with both cancer and chronic viral infections is not well established as most clinical trials of ICIs excluded these patient populations.MethodsWe performed a retrospective analysis of patients with advanced-stage cancers and HIV, HBV, or HCV infection treated with ICI therapy at 5 MedStar Health hospitals from January 2011 to April 2018.ResultsWe identified 50 patients including 16 HIV, 29 HBV/HCV, and 5 with concurrent HIV and either HBV or HCV. In the HIV cohort (n = 21), any grade immune-related adverse events (irAEs) were 24% with grade ≥ 3 irAEs 14%. Among 5 patients with matched pre/post-treatment results, no significant changes in HIV viral load and CD4+ T-cell counts were observed. RECIST confirmed (n = 18) overall response rate (ORR) was 28% with 2 complete responses (CR) and 3 partial responses (PR). Responders included 2 patients with low baseline CD4+ T-cell counts (40 and 77 cells/ul, respectively). In the HBV/HCV cohort (n = 34), any grade irAEs were 44% with grade ≥ 3 irAEs 29%. RECIST confirmed ORR was 21% (6 PR). Among the 6 patients with known pre/post-treatment viral titers (2 HCV and 4 HBV), there was no evidence of viral reactivation.ConclusionsOur retrospective series is one of the largest case series to report clinical outcomes among HIV, HBV and HCV patients treated with ICI therapy. Toxicity and efficacy rates were similar to those observed in patients without chronic viral infections. Viral reactivation was not observed. Tumor responses occurred in HIV patients with low CD4 T-cell counts. While prospective studies are needed to validate above findings, these data support not excluding such patients from ICI–based clinical trials or treatment.

Report this publication

Statistics

Seen <100 times