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Abstract
PURPOSE OF REVIEW As people living with human immunodeficiency virus (HIV, PLWH) age, aging-related comorbidities have come into focus as major challenges to their overall health. In this review, an in-depth overview of the two most commonly encountered chronic lung diseases in PLWH, chronic obstructive pulmonary disease (COPD) and lung cancer, is provided. RECENT FINDINGS The risk for both COPD and lung cancer remains significantly higher in PLWH compared to the HIV-uninfected population, although fortunately rates of lung cancer appear to be declining over the last two decades. Outcomes for PLWH with these conditions, though, continue to be poor with worse survival rates in comparison to the general population. PLWH still face major barriers in accessing care for these conditions, including a higher likelihood of being underdiagnosed with COPD and a lower likelihood of being referred for lung cancer screening or treatment. A lack of evidence for optimal treatment strategies for both COPD and lung cancer still hampers the care of PLWH with these conditions. SUMMARY COPD and lung cancer represent substantial burdens of disease in PLWH. Improved access to standard-of-care screening and treatment and greater investigation into therapeutic responses specifically in this population are recommended.
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Affiliation(s)
- Janice M Leung
- Division of Respiratory Medicine, Department of Medicine
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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2
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Kawai S, Suzuki H, Okuma Y. Durvalumab Consolidation Treatment after Chemoradiotherapy for an HIV-Positive Patient with Locally Advanced Non-Small Cell Lung Cancer. Case Rep Oncol 2020; 13:747-753. [PMID: 32774270 PMCID: PMC7383185 DOI: 10.1159/000507390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 02/05/2023] Open
Abstract
Due to antiretroviral therapy, human immunodeficiency virus (HIV) patients and non-HIV patients have a similar life expectancy. The leading cause of death among HIV patients is lung cancer. However, clinical toxicities with immune checkpoint inhibitors, including durvalumab, in HIV-positive patients with non-small cell lung cancer (NSCLC) remain unknown. We report a 45-year-old Japanese HIV patient, who was safely treated with durvalumab consolidation therapy after concurrent chemoradiotherapy (CCRT) for locally advanced NSCLC without significant toxicities until his disease progressed. This case demonstrates the safety of durvalumab consolidation therapy for HIV-positive patients after CCRT for locally advanced NSCLC.
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Affiliation(s)
- Shoko Kawai
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroe Suzuki
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Pichardo R, Go RF, Qu L, Hussein L, Gupta S. HIV-associated Non-small-cell Lung Cancer with Rearrangement of the Anaplastic Lymphoma Kinase Gene: A Report of Two Patients. Cureus 2019; 11:e5466. [PMID: 31523585 PMCID: PMC6721879 DOI: 10.7759/cureus.5466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/22/2019] [Indexed: 12/03/2022] Open
Abstract
Non-small-cell lung cancer (NSCLC) is the most common non-AIDS defining cancer in patients infected with HIV and has the highest mortality rate among all cancers in this patient population. Treatment of NSCLC in HIV-positive patients is similar to that in HIV-negative patients, but less is known about the molecular characteristics of NSCLC in HIV-positive patients. This report describes two patients with HIV-associated NSCLC and rearrangements of the anaplastic lymphoma kinase (ALK) gene. The disease followed an indolent course in both patients.
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Affiliation(s)
- Rayli Pichardo
- Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, USA
| | | | - Lang Qu
- Internal Medicine, West China School of Medicine, Sichuan University, Chengdu, CHN
| | - Lily Hussein
- Hematology / Oncology, John H Stroger Jr. Hospital of Cook County, Chicago, USA
| | - Shweta Gupta
- Hematology / Oncology, John H Stroger, Jr. Hospital of Cook County, Chicago, USA
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Takahashi S, Okuma Y, Watanabe K, Hosomi Y, Imamura A, Okamura T, Gemma A. Single-institutional experience of clinicopathological analysis and treatment for lung cancer patients with human immunodeficiency virus infection. Mol Clin Oncol 2017; 6:765-769. [PMID: 28515928 PMCID: PMC5431141 DOI: 10.3892/mco.2017.1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/13/2017] [Indexed: 11/05/2022] Open
Abstract
The advent of antiretroviral therapy has changed the disease spectrum constitution among patients living with human immunodeficiency virus (HIV), while the incidence of death due to non-AIDS-defining cancers, particularly lung cancer, continues to increase in the USA and Europe. However, the availability of detailed reports of the clinical characteristics of lung cancer among Asian populations is limited. The present study retrospectively analyzed the clinical characteristics, treatment regimens and outcomes of lung cancer patients with HIV who were treated in a single institution between 1988 and 2013. Of the 20 lung cancer patients living with HIV included in this study, 90% were diagnosed since 1996 in the post-antiretroviral era. The median CD4+ cell count was 373.5/µl, whereas 65% of the patients were diagnosed with adenocarcinoma and 30% with squamous cell carcinoma. Epidermal growth factor receptor mutations were detected in 3 (27%) of the 11 specimens for which data were available, of which 65% had advanced-stage disease. Of the 20 patients, 9 underwent surgery, 6 received radiotherapy and 5 received chemotherapy as a first-line treatment. Treatment was generally well-tolerated. The median survival period was 35.8 months for all stages and 14.0 months for advanced stages. The treatment outcomes in our institution were favorable in comparison with previous studies from the USA and Europe, although these findings may be due to ethnic differences or the efficacy of treatment for HIV and lung cancer.
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Affiliation(s)
- Satoshi Takahashi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
- Division of Oncology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Kageaki Watanabe
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Akifumi Imamura
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Tatsuru Okamura
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
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Kiderlen TR, Siehl J, Hentrich M. HIV-Associated Lung Cancer. Oncol Res Treat 2017; 40:88-92. [PMID: 28259887 DOI: 10.1159/000458442] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/30/2017] [Indexed: 12/27/2022]
Abstract
Lung cancer (LC) is one of the most common non-AIDS (acquired immune deficiency syndrome)-defining malignancies. It occurs more frequently in persons living with human immunodeficiency virus (PLWHIV) than in the HIV-negative population. Compared to their HIV-negative counterparts, patients are usually younger and diagnosed at more advanced stages. The pathogenesis of LC in PLWHIV is not fully understood, but immunosuppression in combination with chronic infection and the oncogenic effects of smoking and HIV itself all seem to play a role. Currently, no established preventive screening is available, making smoking cessation the most promising preventive measure. Treatment protocols and standards are the same as for the general population. Notably, immuno-oncology will also become standard of care in a significant subset of HIV-infected patients with LC. As drug interactions and hematological toxicity must be taken into account, a multidisciplinary approach should include a physician experienced in the treatment of HIV. Only limited data is available on novel targeted therapies and checkpoint inhibitors in the setting of HIV.
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Kojima Y, Iwasaki N, Yanaga Y, Tanuma J, Koizumi Y, Uehira T, Yotsumoto M, Ajisawa A, Hagiwara S, Okada S, Nagai H. End-of-life care for HIV-infected patients with malignancies: A questionnaire-based survey. Palliat Med 2016; 30:869-76. [PMID: 26934946 DOI: 10.1177/0269216316635881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The number of HIV-infected patients who require palliative or end-of-life care is increasing, and the status of end-of-life care for HIV patients with malignancies is unclear. AIM This study aimed to evaluate the end-of-life care provided to HIV patients with malignancies in Japan. DESIGN National cross-sectional questionnaire-based survey. SETTING/PARTICIPANTS Questionnaires were delivered to the medical staff of 378 regional core hospitals/core hospitals for AIDS and 285 palliative care units in Japan. Data were collected between August and October 2013. RESULTS Overall, 226 regional core hospitals/core hospitals for AIDS (59.8%) responded. A total of 55 institutions (24.3%) provided end-of-life care to HIV patients with malignancies. Regarding the place of death of the patients, 69.1% died at the institution whereas 18.2% were transferred to palliative care units. The requests of 16 (29.1%) institutions to transfer patients to palliative care units were rejected. Of the 378 palliative care units, 179 (62.8%) responded. While 13 palliative care units (4.6%) provided care to hospitalized HIV patients with malignancies, 20 (11.2%) refused to accept these patients for treatment because of a lack of experience in treating these patients and a lack of knowledge regarding HIV infection. CONCLUSION Our findings suggest that in Japan, HIV patients with malignancies have difficulties obtaining hospitalization at a palliative care unit, which is likely due to a lack of experience among the professionals in treating such patients as well as a lack of knowledge about HIV.
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Affiliation(s)
- Yuki Kojima
- Department of Hematology and Oncology, Nagoya University Graduate school of Medicine, Nagoya, Japan Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Nami Iwasaki
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yuriko Yanaga
- Center for Infectious Disease and Infection Control, Keio University, Tokyo, Japan
| | - Junko Tanuma
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Koizumi
- Department of Hematology, Shiga University of Medical Science Hospital, Shiga, Japan
| | - Tomoko Uehira
- Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Mihoko Yotsumoto
- Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Ajisawa
- Department of Infectious Disease, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Shotaro Hagiwara
- Department of Hematology, Internal Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Seiji Okada
- Center for AIDS Research, Kumamoto University, Kumamoto, Japan
| | - Hirokazu Nagai
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Abstract
Pulmonary malignancies are a major source of morbidity and mortality in HIV-infected persons. Non-AIDS-defining lung cancers (mostly non-small cell lung cancers) are now a leading cause of cancer death among HIV-infected persons. HIV-associated factors appear to affect the risk of lung cancer and may adversely impact cancer treatment and outcomes. HIV infection also may modify the potential harms and benefits of lung cancer screening with computed tomography. AIDS-defining lung malignancies include pulmonary Kaposi sarcoma and pulmonary lymphoma, both of which are less prevalent with widespread adoption of antiretroviral therapy.
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Affiliation(s)
- Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert Pitts
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Moltó J, Moran T, Sirera G, Clotet B. Lung cancer in HIV-infected patients in the combination antiretroviral treatment era. Transl Lung Cancer Res 2016; 4:678-88. [PMID: 26798577 DOI: 10.3978/j.issn.2218-6751.2015.08.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The advent of combination antiretroviral treatment (cART) has been followed by a decrease in HIV-associated morbidity and mortality, but also by an apparent increase in the incidence of non-AIDS-defining cancers (NADCs). The risk of lung cancer is substantially higher in HIV-infected patients than in the general population, in part due to aging and tobacco use, and it is the most frequent NADC. The management of lung cancer in HIV-infected patients has some peculiarities that need to be taken into account. This review focuses on the epidemiology, risk factors, and clinical management of lung cancer in HIV-infected patients. In addition, screening tools and future perspectives are also discussed.
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Affiliation(s)
- José Moltó
- 1 Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 2 Universitat Autònoma de Barcelona (UAB), Barcelona, Spain ; 3 Medical Oncology Department, Catalan Institute of Oncology (ICO-Badalona), Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 4 Fundació IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 5 Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Spain
| | - Teresa Moran
- 1 Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 2 Universitat Autònoma de Barcelona (UAB), Barcelona, Spain ; 3 Medical Oncology Department, Catalan Institute of Oncology (ICO-Badalona), Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 4 Fundació IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 5 Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Spain
| | - Guillem Sirera
- 1 Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 2 Universitat Autònoma de Barcelona (UAB), Barcelona, Spain ; 3 Medical Oncology Department, Catalan Institute of Oncology (ICO-Badalona), Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 4 Fundació IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 5 Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Spain
| | - Bonaventura Clotet
- 1 Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 2 Universitat Autònoma de Barcelona (UAB), Barcelona, Spain ; 3 Medical Oncology Department, Catalan Institute of Oncology (ICO-Badalona), Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 4 Fundació IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; 5 Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Spain
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Créquit P, Ruppert AM, Rozensztajn N, Gounant V, Vieira T, Poulot V, Antoine M, Chouaid C, Wislez M, Cadranel J, Lavole A. EGFR and KRAS mutation status in non-small-cell lung cancer occurring in HIV-infected patients. Lung Cancer 2015; 96:74-7. [PMID: 27133754 DOI: 10.1016/j.lungcan.2015.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/29/2015] [Accepted: 11/26/2015] [Indexed: 11/25/2022]
Abstract
Non-small-cell lung cancer (NSCLC) is the most common non-acquired immune deficiency syndrome-related malignancy responsible for death. Mutational status is crucial for choosing treatment of advanced NSCLC, yet no data is available on the frequency of epidermal growth factor receptor (EGFR) and Kirsten ras (KRAS) mutations and their impact on NSCLC in human immunodeficiency virus (HIV)-infected patients (HIV-NSCLC). All consecutive HIV-NSCLC patients diagnosed between June 1996 and August 2013 at two Paris university hospitals were reviewed, with tumor samples analyzed for EGFR and KRAS mutational status. Overall, 63 tumor samples were analyzed out of 73 HIV-NSCLC cases, with 63% of advanced NSCLC. There were 60 non-squamous and nine squamous cell carcinomas, with EGFR and KRAS mutations identified in two (3.3%) and seven (11.5%) tumors, respectively. The proportion of KRAS mutations was 29% if solely the more sensitive molecular techniques were considered. The two patients with advanced adenocarcinoma harboring EGFR mutations exhibited lasting partial response to EGFR-tyrosine kinase inhibitors. Overall survival for patients with advanced NSCLC were >30 months for those with EGFR mutations, <3 months for KRAS mutations (n=2), and the median was 9 months [4.1-14.3] for wild-type (n=34). In multivariate analysis, KRAS mutation and CD4<200 cells/μL were associated with poor prognosis (hazard ratio (HR): 24 [4.1-140.2], p=0.0004; HR: 3.1 [1.3-7.5], p=0.01, respectively). EGFR mutation must be investigated in HIV-NSCLC cases due to its predictive and prognostic impact, whereas KRAS mutation is of poor prognostic value. Clinicians should search for drugs dedicated to this target population.
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Affiliation(s)
| | - Anne-Marie Ruppert
- Service de Pneumologie, AP-HP, Hôpital Tenon, Paris, France; Sorbonne Universités, UPMC Univ. Paris 06, GRC-04, Théranoscan, Paris, France
| | | | - Valérie Gounant
- Service de Pneumologie, AP-HP, Hôpital Tenon, Paris, France; Sorbonne Universités, UPMC Univ. Paris 06, GRC-04, Théranoscan, Paris, France
| | - T Vieira
- Service de Pneumologie, AP-HP, Hôpital Tenon, Paris, France; Sorbonne Universités, UPMC Univ. Paris 06, GRC-04, Théranoscan, Paris, France
| | - Virginie Poulot
- Sorbonne Universités, UPMC Univ. Paris 06, GRC-04, Théranoscan, Paris, France; Plateforme de Génomique des Tumeurs solides et Cytologie pathologiques, AP-HP, Hôpital Tenon, Paris, France
| | - Martine Antoine
- Sorbonne Universités, UPMC Univ. Paris 06, GRC-04, Théranoscan, Paris, France; Service d'Anatomie pathologique, AP-HP, Hôpital Tenon, Paris, France
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal, Créteil, France
| | - Marie Wislez
- Service de Pneumologie, AP-HP, Hôpital Tenon, Paris, France; Sorbonne Universités, UPMC Univ. Paris 06, GRC-04, Théranoscan, Paris, France
| | - Jacques Cadranel
- Service de Pneumologie, AP-HP, Hôpital Tenon, Paris, France; Sorbonne Universités, UPMC Univ. Paris 06, GRC-04, Théranoscan, Paris, France
| | - Armelle Lavole
- Service de Pneumologie, AP-HP, Hôpital Tenon, Paris, France; Sorbonne Universités, UPMC Univ. Paris 06, GRC-04, Théranoscan, Paris, France.
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