Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 5;21(1):776.
doi: 10.1186/s12885-021-08514-z.

The association between protease inhibitors and anal cancer outcomes in veterans living with HIV treated with definitive chemoradiation: a retrospective study

Alison K Yoder  1   2 , David S Lakomy  2   3 , Yongquan Dong  4   5 , Suchismita Raychaudhury  4   5 , Kathryn Royse  4 , Christine Hartman  4   5 , Peter Richardson  4   5 , Donna L White  4   5 , Jennifer R Kramer  4   5 , Lilie L Lin  2 , Elizabeth Chiao  6   7
Affiliations

The association between protease inhibitors and anal cancer outcomes in veterans living with HIV treated with definitive chemoradiation: a retrospective study

Alison K Yoder et al. BMC Cancer. .

Abstract

Background: The incidence of anal squamous cell carcinoma has been increasing, particularly in people living with HIV (PLWH). There is concern that radiosensitizing drugs, such as protease inhibitors, commonly used in the management of HIV, may increase toxicities in patients undergoing chemoradiation. This study examines treatment outcomes and toxicities in PLWH managed with and without protease inhibitors who are receiving chemoradiation for anal cancer.

Methods: Patient demographic, HIV management, and cancer treatment information were extracted from multiple Veterans Affairs databases. Patients were also manually chart reviewed. Among PLWH undergoing chemoradiation for anal carcinoma, therapy outcomes and toxicities were compared between those treated with and without protease inhibitors at time of cancer treatment. Statistical analysis was performed using chi-square, Cox regression analysis, and logistic regression.

Results: A total of 219 PLWH taking anti-retroviral therapy undergoing chemoradiation for anal cancer were identified and included in the final analysis. The use of protease inhibitors was not associated with any survival outcome including colostomy-free survival, progression-free survival, or overall survival (all adjusted hazard ratio p-values> 0.05). Regarding toxicity, protease inhibitor use was not associated with an increased odds of hospitalizations or non-hematologic toxicities; however, protease inhibitor use was associated with increased hospitalizations for hematologic toxicities, including febrile neutropenia (p < 0.01).

Conclusion: The use of protease inhibitors during chemoradiation for anal carcinoma was not associated with any clinical outcome or increase in non-hematologic toxicity. Their use was associated with increased hospitalizations for hematologic toxicities. Further prospective research is needed to evaluate the safety and efficacy of protease inhibitors for patients undergoing chemoradiation.

Keywords: Anal carcinoma; Chemoradiation; HIV; Protease inhibitors; Squamous cell carcinoma.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient Selection
Fig. 2
Fig. 2
Kaplan-Meier Curves of overall survival, recurrence-free survival, and colostomy-free survival of PLWH undergoing definitive chemoradiation for anal cancer who took protease inhibitors compared to those who did not
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34. doi: 10.3322/caac.21551. - DOI - PubMed
    1. Nelson VM, Benson AB., 3rd Epidemiology of Anal Canal Cancer. Surg Oncol Clin N Am. 2017;26(1):9–15. doi: 10.1016/j.soc.2016.07.001. - DOI - PubMed
    1. Palefsky JM, Holly EA, Efirdc JT, Da Costa M, Jay N, Berry JM, et al. Anal intraepithelial neoplasia in the highly active antiretroviral therapy era among HIV-positive men who have sex with men. Aids. 2005;19(13):1407–1414. doi: 10.1097/01.aids.0000181012.62385.4a. - DOI - PubMed
    1. Crum-Cianflone NF, Hullsiek KH, Marconi VC, Ganesan A, Weintrob A, Barthel RV, et al. Anal cancers among HIV-infected persons: HAART is not slowing rising incidence. 2010;24(4):535–43. 10.1097/QAD.0b013e328331f6e2. - PMC - PubMed
    1. Pappou EP, Magruder JT, Fu T, Hicks CW, Herman JM, Fang S, Wick EC, Safar B, Gearhart SL, Efron JE. Prognostic and predictive Clinicopathologic factors of squamous Anal Canal Cancer in HIV-positive and HIV-negative patients: does HAART influence outcomes? World J Surg. 2018;42(3):876–883. doi: 10.1007/s00268-017-4201-6. - DOI - PMC - PubMed

Substances