New 'safe' therapy offers hope for cancer patients with HIV

A new category of immunotherapies called checkpoint inhibitors appears safe to use in patients with both advanced malignancies and HIV according to a recent studyPrincipal Investigator Thomas Uldrick of the HIV amp AIDS Malignancy Branch at the National Cancer Institute will present late breaking results from the first 17 patients on a phase I study of pembrolizumab in patients with HIV and advanced cancers at the Society for Immunotherapy of Cancers annual meeting in National Harbor MarylandRepresentational pictureDuring the development of these drugs people with HIV were routinely excluded from studies due to concerns that they would not tolerate these medications or perhaps not benefit from them because of their underlying HIV and associated immune dysfunction Uldrick said The most important first step was to show that this class of drug would be safe in cancer patients with HIVStudy participants who were on standard antiretroviral therapy to control their HIV infections and had various cancers that had failed to respond to standard therapies received pembrolizumab Keytruda known since 2015 as the Jimmy Carter drug after it swiftly beat back melanoma that had spread to the former presidents brain and liverThese drugs are the backbone of cancer immunotherapy at present and have been shown to be effective in subsets of virtually every different kind of cancer said senior author Martin Mac Cheever For patients with HIV who are using effective antiretroviral therapy and have cancers for which these drugs are approved theres no reason not to consider these drugs as standard therapyFrom the earliest days of the AIDS pandemic Kaposi sarcoma a rarely seen cancer until then was one of a trio of cancers known as AIDSdefining malignancies It nonHodgkin lymphoma and in women cervical cancer often signaled that a persons HIV infection had progressed to fullblown AIDS People did not die of AIDS per se They died of one of these cancers or of infections like pneumocystis pneumonia and toxoplasmosis that took advantage of a weakened immune systemThe ongoing study will enroll up to 36 patients and there are plans to include more patients with Kaposi sarcoma a cancer for which checkpoint inhibitors have not been studied It is one of the leading causes of cancer deaths in subSaharan Africa where HIV rates are high and new treatments are sorely neededAlso to be presented Friday is the death of one patient later in the study who had Kaposi sarcoma The death is still being evaluated but was likely due to dissemination of KSHV Uldrick and Cheever said review of the case suggests the patient had a history of symptomatic KSHV viremia and the study has been changed to exclude such patients in the future and provide specific guidelines for management should new symptomatic KSHV viremia be observedSix other study participants with Kaposi sarcoma or primary effusion lymphoma have been treated on this study None has experienced similar problems and some have benefitted from therapy Uldrick saidWe do not believe that this takes away from the safety message in patients with HIV and other better studied cancers Uldrick said However more experience is clearly needed in treating KSHVassociated diseases with checkpoint inhibitors