Concomitant Chemoradiotherapy and Antiretroviral Therapy for HIV-Infected Patients with Locoregionally Advanced Non-Small Cell Lung Cancer: Benefit and Tolerability of Treatment in 2 Cases

Abstract

Background: Human immunodeficiency virus (HIV)-infected patients are surviving longer since the advent of antiretroviral therapy. Therefore, more patients are developing non-AIDS-defining cancers which increasingly determine mortality. Case Reports: Here we present 2 cases of locally advanced non-small cell lung cancer treated initially with concomitant chemoradiotherapy and antiretroviral therapy. Both patients were male, ages 69 and 66, with known HIV infection and immunologically stable on antiretroviral therapy. Presenting symptoms included superior sulcus tumor with left arm immobility and sensory disturbance in case 1 and right lower bronchus constriction in case 2. Symptoms were controlled by chemoradiotherapy. Conclusion: These cases illustrate that intensive anticancer therapy administered to the HIV-infected population can be tolerated even though these patients seem to be too fragile for both chemotherapy and radiotherapy, especially since the potential benefit remains uncertain. Recent improvements in chemoradiotherapy and supportive care have enhanced tolerance for such therapy.

Durvalumab Consolidation Treatment after Chemoradiotherapy for an HIV-Positive Patient with Locally Advanced Non-Small Cell Lung Cancer

“…However, appropriate clinical practice, including optimal dosages, remains uncertain for cancer patients with HIV and fragile bone marrow function [7]. Conversely, it has also been reported that standard therapy for HIV-positive lung cancer patients undergoing ART achieve good outcomes, which are similar to those seen in HIV-negative patients with advanced NSCLC [8, 9].…”

Systemic treatment and radiotherapy for patients with non-small cell lung cancer (NSCLC) and HIV infection – A systematic review

“…An additional study was retrieved after cross-referencing. Among them, 21 studies, published between 1998 and 2021 were included: 12 assessed the efficacy and/or toxicity of chemotherapy [12][13][14][15][16][17][18][19][20][21][22][23], six described immunotherapy [24][25][26][27][28][29], three reported on tyrosine kinase inhibitors (TKIs) [20,30,31], and eight assessed radiotherapy [13][14][15][16][17]20,22,32]. They included a total of 543 patients with lung tumors, of which 513 with NSCLC.…”

“…Four of the studies were from North America (all from the USA) [14,24,26,28], 11 from Europe [12,17,18,25,31,29], one from Europe and the USA [13], and 5 from Asia (all from Japan) [16,20,21,30,32] -Table 1.…”

“…ART regimen was reported in six (out of 10) chemotherapy studies and in four (out of six) immuno-therapy studies. In the chemotherapy studies (published during 2004-2012), 35 %-52 % of the ART regimens were based on protease inhibitors, but the use of integrase strand transfer inhibitors (INSTIs) was not reported [12][13][14][15]19,20]. On the other hand, in the more recent studies concerning immunotherapy (published during 2018-2020), 17-28 % of patients were on protease inhibitors, while 25 %-85 % were on INSTIs [24,26,27,29].…”

Single-institutional experience of clinicopathological analysis and treatment for lung cancer patients with human immunodeficiency virus infection

“…Concurrent chemoradiotherapy was the most common reason among patients deemed unfit for standard care. However, 3 patients recently received chemoradiotherapy concurrent with platinum-doublet chemotherapy (18), without reported severe toxicity or treatment-related deaths.…”