Updated:04/09/2020 17: 39h
A study published today in a journal JAMA Oncology confirms the safety of immunotherapy oncology treatments in people with HIV, opening the door to the use of these drugs in this group of patients. Until now, people with HIV were excluded from trials with these therapies because it was considered that by affecting the virus to your immune system, the therapy was not suitable for them.
People infected with HIV have a life expectancy similar to that of the general population, since antiretroviral treatments manage to control the p virusfor life. However, they live in a situation of chronic inflammation that favors development of tumors at younger ages. In high-income countries, where access to antiretrovirals is guaranteed, lung cancer is the leading cause of death for cancer in people with HIV.
“Until now, people with HIV were systematically excluded from trials with new cancer immunotherapies, making this research the first in its field in Europe,” explains María González Cao, member of the Spanish Lung Cancer Group (GECP) and specialist of the Dr. Rosell Oncological Institute at the Dexeus University Hospital. Exclusion was based on fear that anticancer treatment reactivate HIV, had greater toxicity than in other cases, or further impaired the immune system of patients.
González Cao proposed the study when he realized that people with HIV who had cancer were in a situation of inferiority when accessing cancer treatments. «Immunotherapies based on the use of antibodies against proteins PD-1 or PD-L1 have revolutionized cancer treatment in recent years, achieving long survivors, in some cases even healings, in 20-50% of patients affected by advanced and metastatic tumors » , Explain. We started the study because we wanted to offer the same opportunities to all patients, “he adds.
The work included 20 cancer patients and HIV infection treated with antiretroviral medication. Fifteen of them had lung cancer, 2 melanoma, 2 anal carcinoma and 1 bladder cancer.
The trial shows that Durvalumab, an antibody against the PD-L1 protein, is safe and active in people with HIV infection. 50% of the treated patients, 75% with lung cancer, obtained a clear clinical benefit, suggesting at least the same proportion of success cases as in patients without HIV. Some of the study participants are long survivors who today maintain their response to treatment and are free of gross tumor disease. None had serious drug-related toxicities.
According Rafael Rosell, principal investigator of the study: “Initial data suggests that there may be even better immunotherapy activity and tolerance than in other patient populations. This is something that we must continue investigating, since it could have implications when developing new treatments for the general population ”.
Regarding the HIV, the results indicate that the administration of Durvalumab did not increase the viral load in the blood of any of the patients, and that the levels of immune cells CD4 and CD8 they remained stable.
The work is also looking at the effect of the drug on HIV. “We want to study whether immunotherapy has been able to have beneficial effects on the viral load of patients. AntiPD-1 / PD-L1 therapies, by strengthening the immune system, can theoretically be effective in many processes where immunity plays a fundamental role, such as viral infections. But we are still in an initial phase of study “, explains Dr. Javier Martínez-Picado, researcher ICREA of the IrsiCaixa AIDS Research Institute.
The study has been promoted by the Spanish Lung Cancer Group (GECP) and has been developed at the IrsiCaixa AIDS Research Institute, the Panoncology Oncology laboratory of the Dr. Rosell Oncology Institute of the Hospital Universitari Dexeus and the Pompeu Fabra University of Barcelona. Eight hospital centers in Spain, belonging to the GECP, have participated: Catalan Institute of Oncology at the Germans Trias i Pujol Hospital in Badalona, Hospital Clínic in Barcelona, Virgen del Rocío in Seville, Hospital La Fe in Valencia, Hospital La Paz in Madrid, Hospital Mutua Terrassa de Barcelona, General University Hospital of Alicante and Puerta de Hierro de Madrid.