1
|
Brandão M, Durieux V, Auprih M, Fozza A, Dauby N, Cuccia F, Aspeslagh S, Verhaert M, Giaj-Levra N. Systemic treatment and radiotherapy for patients with non-small cell lung cancer (NSCLC) and HIV infection - A systematic review. Lung Cancer 2023; 178:75-86. [PMID: 36806897 DOI: 10.1016/j.lungcan.2023.01.010] [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: 10/27/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
Lung cancer is the most common non-AIDS defining cancer among people living with HIV (PLWH), but there is a paucity of data regarding the efficacy and toxicity of radiotherapy and systemic regimens, including immunotherapy, in the treatment of these patients. In order to answer this question, we have performed a systematic search of the literature in Ovid Medline until March 17, 2022. We included 21 publications, enrolling 513 PLWH with non-small cell lung cancer (NSCLC), mostly male (75-100%), (ex-)smokers (75-100%) and with stage III-IV at diagnosis (65-100%). The overall response rate (ORR) to chemotherapy (n = 186 patients, mostly receiving platinum-based regimens) was highly variable (17 %-83 %), with a substantial hematological toxicity. ORR varied between 13 % and 50 % with single-agent immunotherapy (n = 68), with median overall survival between 9 and 11 months and a very acceptable toxicity profile, in line with studies in the HIV non-infected population. All five patients receiving tyrosine kinase inhibitors (TKIs; gefitinib or erlotinib) showed a partial response and long overall survival. Yet, combination of TKIs with antiretroviral therapy using pharmacological boosters, such as ritonavir, should be avoided. Radiotherapy was evaluated among 42 patients, showing high ORR (55 %-100 %), but 18 % of patients had a pneumonitis. This systematic review shows that radiotherapy and systemic therapy are effective and safe among PLWH with controlled infection diagnosed with NSCLC. Nonetheless, most reports were small and heterogeneous and larger studies are needed to confirm these encouraging findings. Moreover, clinical trials should not restrict the inclusion of PLWH, as more data is needed regarding the long-term efficacy and safety of treatments among this underserved population, especially of immunotherapy.
Collapse
Affiliation(s)
- Mariana Brandão
- Medical Oncology Department, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Rue Meylemeersch 90, 1070 Brussels, Belgium.
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (U.L.B.), Route de lennik 808, 1070 Brussels, Belgium.
| | - Maša Auprih
- Medical Oncology Department, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Rue Meylemeersch 90, 1070 Brussels, Belgium
| | - Alessandra Fozza
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy.
| | - Nicolas Dauby
- Department of Infectious Diseases, CHU Saint-Pierre, Rue haute 322, 1000 Brussels, Belgium; School of Public Health, Université Libre de Bruxelles (U.L.B.), Route de lennik 808, 1070 Brussels, Belgium.
| | - Francesco Cuccia
- Radiotherapy Unit, ARNAS Civico Hospital - Piazza Nicola Leotta 4, 90100 Palermo, Italy.
| | - Sandrine Aspeslagh
- Vrije Universiteit Brussel (V.U.B.), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Medical Oncology, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Marthe Verhaert
- Vrije Universiteit Brussel (V.U.B.), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Medical Oncology, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A.Sempreboni, 37124 Negrar di Valpolicella, Italy.
| |
Collapse
|
2
|
Li M, Radvanyi L, Yin B, Rycaj K, Li J, Chivukula R, Lin K, Lu Y, Shen J, Chang DZ, Li D, Johanning GL, Wang-Johanning F. Downregulation of Human Endogenous Retrovirus Type K (HERV-K) Viral env RNA in Pancreatic Cancer Cells Decreases Cell Proliferation and Tumor Growth. Clin Cancer Res 2017; 23:5892-5911. [PMID: 28679769 DOI: 10.1158/1078-0432.ccr-17-0001] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 05/09/2017] [Accepted: 06/29/2017] [Indexed: 12/23/2022]
Abstract
Purpose: We investigated the role of the human endogenous retrovirus type K (HERV-K) envelope (env) gene in pancreatic cancer.Experimental Design: shRNA was employed to knockdown (KD) the expression of HERV-K in pancreatic cancer cells.Results: HERV-K env expression was detected in seven pancreatic cancer cell lines and in 80% of pancreatic cancer patient biopsies, but not in two normal pancreatic cell lines or uninvolved normal tissues. A new HERV-K splice variant was discovered in several pancreatic cancer cell lines. Reverse transcriptase activity and virus-like particles were observed in culture media supernatant obtained from Panc-1 and Panc-2 cells. HERV-K viral RNA levels and anti-HERV-K antibody titers were significantly higher in pancreatic cancer patient sera (N = 106) than in normal donor sera (N = 40). Importantly, the in vitro and in vivo growth rates of three pancreatic cancer cell lines were significantly reduced after HERV-K KD by shRNA targeting HERV-K env, and there was reduced metastasis to lung after treatment. RNA-Seq results revealed changes in gene expression after HERV-K env KD, including RAS and TP53. Furthermore, downregulation of HERV-K Env protein expression by shRNA also resulted in decreased expression of RAS, p-ERK, p-RSK, and p-AKT in several pancreatic cancer cells or tumors.Conclusions: These results demonstrate that HERV-K influences signal transduction via the RAS-ERK-RSK pathway in pancreatic cancer. Our data highlight the potentially important role of HERV-K in tumorigenesis and progression of pancreatic cancer, and indicate that HERV-K viral proteins may be attractive biomarkers and/or tumor-associated antigens, as well as potentially useful targets for detection, diagnosis, and immunotherapy of pancreatic cancer. Clin Cancer Res; 23(19); 5892-911. ©2017 AACR.
Collapse
Affiliation(s)
- Ming Li
- Viral Oncology Program, Center for Cancer and Metabolism, SRI International, Menlo Park, California
| | - Laszlo Radvanyi
- EMD Serono Research and Development Institute, Billerica, Massachusetts
| | - Bingnan Yin
- Department of Inflammation and Epigenetics, Methodist Research Institute, Houston, Texas
| | | | - Jia Li
- Viral Oncology Program, Center for Cancer and Metabolism, SRI International, Menlo Park, California
| | - Raghavender Chivukula
- Viral Oncology Program, Center for Cancer and Metabolism, SRI International, Menlo Park, California
| | - Kevin Lin
- Department of Epigenetics and Molecular Carcinogenesis, Science Park, the University of Texas MD Anderson Cancer Center, Smithville, Texas
| | - Yue Lu
- Department of Epigenetics and Molecular Carcinogenesis, Science Park, the University of Texas MD Anderson Cancer Center, Smithville, Texas
| | - JianJun Shen
- Department of Epigenetics and Molecular Carcinogenesis, Science Park, the University of Texas MD Anderson Cancer Center, Smithville, Texas
| | - David Z Chang
- Virginia Oncology Associates, Newport News, Virginia
| | - Donghui Li
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gary L Johanning
- Viral Oncology Program, Center for Cancer and Metabolism, SRI International, Menlo Park, California
| | - Feng Wang-Johanning
- Viral Oncology Program, Center for Cancer and Metabolism, SRI International, Menlo Park, California.
| |
Collapse
|
3
|
Deeken JF, Beumer JH, Anders NM, Wanjiku T, Rusnak M, Rudek MA. Preclinical assessment of the interactions between the antiretroviral drugs, ritonavir and efavirenz, and the tyrosine kinase inhibitor erlotinib. Cancer Chemother Pharmacol 2015; 76:813-9. [PMID: 26330331 PMCID: PMC4577782 DOI: 10.1007/s00280-015-2856-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/25/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE Prevalence of non-AIDS-defining cancers (NADCs) has increased in the era of potent antiretroviral treatments. Incidence rates of NADCs now exceed AIDS-defining cancers in HIV-positive patients. Treatment of NADCs may be complicated by interactions between antiretrovirals and chemotherapy mostly via inhibition or induction of CYP3A4. Erlotinib is used to treat non-small cell lung and pancreatic cancer and is primarily metabolized by CYP3A4 into multiple products including the active metabolite (OSI-420). Preclinical in vivo assessment was performed to gain a better understanding of CYP3A4-mediated interactions between antiretrovirals and erlotinib. METHODS Erlotinib (50 mg/kg p.o.) was administered to male FVB mice in the presence and absence of dexamethasone (10 mg/kg p.o. QDx4), efavirenz (25 mg/kg p.o. QDx4), ketoconazole (50 mg/kg p.o.), or ritonavir (12.5 mg/kg p.o.). Blood samples were collected to characterize exposure (AUC). RESULTS Administration of erlotinib with CYP3A4 inducers (dexamethasone) and inhibitors (ketoconazole and ritonavir) resulted in significant alterations in erlotinib exposure. Ketoconazole and ritonavir resulted in a 1.7- and 3.0-fold increase in erlotinib AUC, respectively, while dexamethasone results in a 0.6-fold decrease in erlotinib AUC. The CYP3A4 inducer efavirenz did not have a significant effect on erlotinib exposure. CONCLUSION CYP3A4 inducers and inhibitors altered the exposure of erlotinib. Until a definitive clinical trial is performed, erlotinib should be used with caution in patients on a ritonavir-containing antiretroviral regimen, while standard doses may be appropriate for patients on an efavirenz-containing antiretroviral regimen.
Collapse
Affiliation(s)
- John F Deeken
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
- INOVA Comprehensive Cancer and Research Institute, Virginia Commonwealth University, INOVA Campus, Falls Church, VA, USA
| | - Jan H Beumer
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Nicole M Anders
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans Street, Bunting-Blaustein Cancer Research Bldg. Room 1M52, Baltimore, MD, 21231-1000, USA
| | - Teresia Wanjiku
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans Street, Bunting-Blaustein Cancer Research Bldg. Room 1M52, Baltimore, MD, 21231-1000, USA
| | - Milan Rusnak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Michelle A Rudek
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans Street, Bunting-Blaustein Cancer Research Bldg. Room 1M52, Baltimore, MD, 21231-1000, USA.
| |
Collapse
|
4
|
A multi-institutional study of clinicopathological features and molecular epidemiology of epidermal growth factor receptor mutations in lung cancer patients living with human immunodeficiency virus infection. J Cancer Res Clin Oncol 2015; 141:1669-78. [PMID: 25800620 DOI: 10.1007/s00432-015-1956-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 03/12/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Lung cancer has become a crucial problem among individuals living with the human immunodeficiency virus (HIV) and causes high mortality in Western countries. Japan has an increasing number of newly infected HIV patients, and lung cancer is becoming a theme in this population. However, clinical factors of this particular population in East Asian are unclear given the identification of ethnic differences in lung cancer in the general population. METHODS From 1986 to 2013, a retrospective nationwide study involving Japanese patients living with HIV and diagnosed with lung cancer was undertaken. RESULTS Forty-three lung cancer patients with HIV were identified (median age, 60.0 years; males, 97.7%; early-stage cancer, 37.2%; metastatic cancer, 34.9%), 41 (95.3%) of whom developed lung cancer in the antiretroviral era. The median CD4-positive T-cell count was 326 cells/µL. Adenocarcinoma was the most frequent histology (55.8%), followed by squamous cell carcinoma (27.9%). Epidermal growth factor receptor (EGFR) status was examined in 14 patients; five (35.7%) had EGFR mutations. The median overall survival time was 25.1 months for all stages and 7.9 months for advanced-stage cancer. Using univariate analysis, the only favorable prognostic factor for overall survival was cancer stage (p = 0.02). CONCLUSIONS The incidence of lung cancer among HIV patients in Japan has been increasing in the past decade. The present Japanese cohort showed similar EGFR mutation status similar to that of general population. The ethnic differences known in the general population were seen even in the population living with HIV, implying distinct clinical characteristics and outcomes from those reported in Western countries.
Collapse
|
5
|
Association of Merkel cell polyomavirus infection with EGFR mutation status in Chinese non-small cell lung cancer patients. Lung Cancer 2014; 83:341-6. [PMID: 24485957 DOI: 10.1016/j.lungcan.2014.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 12/11/2013] [Accepted: 01/03/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Female lung cancer patients with no smoking habit and non-mucinous adenocarcinoma have a higher rate of epidermal growth factor receptor (EGFR) gene mutations, which is related to tyrosine kinase inhibitors (TKIs) sensitivity. Unfortunately the cause of EGFR gene mutations is still elusive. In this study, we search for the association between Merkel cell polyomavirus (MCPyV) infection and EGFR gene mutations. MATERIALS AND METHODS We studied 189 non-small cell lung cancer (NSCLC) samples for the presence of MCPyV large T (LT) DNA, LT antigen and EGFR hotspot mutations. Clinicopathological parameters of this cohort were also analyzed. RESULTS Thirty out of 163 adenocarcinoma and 2 out of 18 squamous cell carcinoma were found to have MCPyV LT DNA by PCR. Immunostaining also showed LT protein expression in most of the DNA positive samples. EGFR mutations were more frequently detected in female (P=0.009) and non-smoking patients (P=0.0001). Furthermore, a significant association between MCPyV infection and EGFR mutations was found (P=0.001). CONCLUSION Our study shows that MCPyV LT DNA is present in a subgroup of NSCLC, which is significantly correlated with EGFR mutations. To the best of our knowledge, this is the first study to find an association between MCPyV infection and EGFR hotspot mutations. These results support the possibility that MCPyV has a partial role in the carcinogenesis of NSCLC in a subgroup of patients.
Collapse
|
6
|
Lavolé A, Toper C, Belmont L, Ruppert AM, Wislez M, Cadranel J. [Lung cancer and HIV infection]. Rev Mal Respir 2013; 31:133-41. [PMID: 24602680 DOI: 10.1016/j.rmr.2013.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 07/11/2013] [Indexed: 01/18/2023]
Abstract
AIDS was the cause of the majority of deaths from HIV infection before 1996 but since the introduction of antiretroviral therapies the causes of mortality have changed considerably. In 2010, 75 % of deaths were due to diseases other than AIDS, the majority being cancers. Lung cancer is the most common in terms of both incidence and mortality. It shows specific features when compared to the general population: there is an excess risk due to heavy smoking but also probably due to immunosuppression. The age of onset is younger and the prognosis worse than in the general population. Management is difficult, partly due to the aggressive nature of the tumor and partly to co-morbidities and potential interactions between anticancer and antiretroviral therapies. A phase II therapeutic trial (IFCT-CHIVA 1001) is under way nationally.
Collapse
Affiliation(s)
- A Lavolé
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France.
| | - C Toper
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - L Belmont
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
| | - A-M Ruppert
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
| | - M Wislez
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
| | - J Cadranel
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
| |
Collapse
|