Human immunodeficiency virus-associated primary lung cancer in the era of highly active antiretroviral therapy: a multi-institutional collaboration.
BACKGROUND
Human immunodeficiency virus (HIV)-infected individuals are at increased risk for primary lung cancer (LC). We wished to compare the clinicopathologic features and treatment outcome of HIV-LC patients with HIV-indeterminate LC patients. We also sought to compare behavioral characteristics and immunologic features of HIV-LC patients with HIV-positive patients without LC.


METHODS
A database of 75 HIV-positive patients with primary LC in the HAART era was established from an international collaboration. These cases were drawn from the archives of contributing physicians who subspecialize in HIV malignancies. Patient characteristics were compared with registry data from the Surveillance Epidemiology and End Results program (SEER; n = 169,091 participants) and with HIV-positive individuals without LC from the Adult and Adolescent Spectrum of HIV-related Diseases project (ASD; n = 36,569 participants).


RESULTS
The median age at HIV-related LC diagnosis was 50 years compared with 68 years for SEER participants (P < .001). HIV-LC patients, like their SEER counterparts, most frequently presented with stage IIIB/IV cancers (77% vs. 70%), usually with adenocarcinoma (46% vs. 47%) or squamous carcinoma (35% vs. 25%) histologies. HIV-LC patients and ASD participants had comparable median nadir CD4+ cell counts (138 cells/µL vs. 160 cells/µL). At LC diagnosis, their median CD4+ count was 340 cells/µL and 86% were receiving HAART. Sixty-three HIV-LC patients (84%) received cancer-specific treatments, but chemotherapy-associated toxicity was substantial. The median survival for both HIV-LC patients and SEER participants with stage IIIB/IV was 9 months.


CONCLUSIONS
Most HIV-positive patients were receiving HAART and had substantial improvement in CD4+ cell count at time of LC diagnosis. They were able to receive LC treatments; their tumor types and overall survival were similar to SEER LC participants. However, HIV-LC patients were diagnosed with LC at a younger age than their HIV-indeterminate counterparts. Future research should explore how screening, diagnostic and treatment strategies directed toward the general population may apply to HIV-positive patients at risk for LC.
Division of Hematology/Oncology, Virginia Mason Medical Center, Seattle, WA, USA.
Gabriela A
GA
D'Jaen
Liron
L
Pantanowitz
Mark
M
Bower
Susan
S
Buskin
Nancy
N
Neil
Erin M
EM
Greco
Timothy P
TP
Cooley
David
D
Henry
Jonathan
J
Stem
Bruce J
BJ
Dezube
Justin
J
Stebbing
David M
DM
Aboulafia
D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002648:Child; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007391:International Cooperation; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018426:SEER Program / Q000706:statistics & numerical data; D013534:Survival; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents