Safety and activity of immune checkpoint inhibitors in people living with HIV and cancer

People living with HIV remain at higher risk than people living without HIV for developing various cancers that can be treated with immune checkpoint inhibitors (ICIs). Since people living with HIV may have dysfunctional immune systems, there have been safety and efficacy concerns for including them in clinical trials of ICIs. Consequently, these studies have either entirely excluded people living with HIV or have limited their participation to specific inclusion criteria.

To evaluate the use of ICIs among people living with HIV, physicians at Dana-Farber Cancer Institute built the international and multi-institutional consortium Cancer Therapy using checkpoint inhibitors in PWH-International (CATCH-IT). They found that ICIs were safe and had differential activity across tumor types.

Additionally, among people living with HIV who have non-small cell lung cancer (NSCLC), clinical outcomes were not influenced by CD4+ T-cell counts or anti-retroviral therapies and the safety and activity of ICIs were comparable to a matched cohort of people living with and without HIV who had metastatic NSCLC. The study is published in the Journal of Clinical Oncology.

This study should reassure physicians that the use of ICIs is safe and effective in people living with HIV, especially those on anti-retroviral therapy, and supports the findings of published clinical trials and retrospective studies of people living with HIV receiving ICIs.

This analysis represents the largest comprehensive analysis to date to include people living with HIV receiving ICIs and the first to formally compare their outcomes and safety profiles to people living without HIV in a subset of patients with metastatic NSCLC.

Overall, the authors believe that this effort represents a stepping-stone that will motivate further studies involving patients living with HIV and cancer and better inform treatment decisions for this unique population.