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. 2023 Apr:178:75-86.
doi: 10.1016/j.lungcan.2023.01.010. Epub 2023 Jan 21.

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

Mariana Brandão  1 , Valérie Durieux  2 , Maša Auprih  3 , Alessandra Fozza  4 , Nicolas Dauby  5 , Francesco Cuccia  6 , Sandrine Aspeslagh  7 , Marthe Verhaert  8 , Niccolò Giaj-Levra  9
Affiliations

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

Mariana Brandão et al. Lung Cancer. 2023 Apr.

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.

Keywords: Chemotherapy; HIV; Immunotherapy; Lung cancer; Radiotherapy; Survival; Toxicity.

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Conflict of interest statement

Declaration of Competing Interest MB: travel grant from Roche and Takeda; speaker honoraria from Roche and Janssen; advisory board participation for Sanofi. ND: speaker honoraria from Boerhinger-Ingelheim; advisory board participation for Roche therapeutics; travel grant from MSD. SA: membership on an advisory board or board of directors:MSD, Sanofi, Roche, BMS, Pfizer. NGL: travel grant from Philips; speaker honoraria from AstraZeneca, IPSEN, FERRING. The remaining authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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