The National Comprehensive Cancer Network (NCCN) has released brand new NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) intended to help make sure people living with HIV (PLWH) who are diagnosed with cancer receive safe, necessary treatment. In 2010, an estimated 7,760 PLWH in the United States were diagnosed with cancer, representing an approximately 50% higher rate than the general population. However, studies have found PLWH are treated for cancer at significantly lower rates than HIV-negative people with cancer, despite most treatment courses being safe and effective in this population.
“The disparity in cancer care is large and significant. For most cancers, people living with HIV are two-to-three times more likely to receive no cancer treatment compared to uninfected people,” said Gita Suneja, MD, Duke Cancer Institute. Dr. Suneja is Co-Chair of the NCCN Guidelines Panel for Cancer in People Living With HIV. “Although we don’t yet know all the reasons for these large differences in cancer treatment, the lack of clinical management guidelines available to clinicians has been shown to be one contributing factor.”
The most-common types of cancer occurring in people living with HIV are, in order of incidence: non-Hodgkin’s lymphoma, Kaposi sarcoma, lung cancer, anal cancer, prostate cancer, liver cancer, colorectal cancer, Hodgkin lymphoma, oral/pharyngeal cancer, female breast cancer, and cervical cancer. The new NCCN Guidelines for Cancer in People Living With HIV includes general advice — while highlighting the importance of working in collaboration with an HIV specialist — as well as specific treatment recommendations for non-small cell lung cancer (NSCLC), anal cancer, Hodgkin lymphoma, and cervical cancer. Additional recommendations can be found in the recently-released NCCN Guidelines for AIDS-Related Kaposi Sarcoma as well as the AIDS-related B-cell lymphomas section of the NCCN Guidelines for B-cell Lymphomas.
“The ultimate goal is to improve cancer survival among people living with HIV,” said Dr. Suneja. “With modern antiretroviral therapy (ART), people with HIV are living longer and therefore getting more cancers related to both HIV infection and aging. The bottom line is that the cancer burden is growing – in fact cancer is quickly becoming the leading cause of death in people living with HIV – so we urgently need to improve cancer treatment in this population.”
Among the recommendations found in the new NCCN Guidelines:
- Most PLWH who develop cancer should be offered the same cancer therapies as HIV-negative individuals, and modifications to cancer treatment should not be made solely on the basis of HIV status.
- Care for patients diagnosed with HIV should be co-managed with an oncologist and an HIV specialist (visit locator.hiv.gov to find local specialists in the United States).
- Oncologists and HIV clinicians, along with HIV and oncology pharmacists, if available, should review proposed cancer therapy and ART for possible drug-drug interactions and overlapping toxicity concerns prior to initiation of therapy.
“One of the most important points we want providers to be aware of surrounds the potential for drug interactions and overlapping toxicities between cancer therapeutics and ART,” said Erin Reid, MD, UC San Diego Moores Cancer Center. Dr. Reid is Co-chair of the NCCN Guidelines Panel for Cancer in People Living With HIV and Vice-Chair of the AIDS Malignancy Consortium Lymphoma Working Group. “Some antiretroviral-cancer therapeutic combinations have serious risk of increased toxicity, while others may reduce levels of either cancer therapeutics or the antiretroviral. The good news is that with the expansion of antiretroviral combinations available, there is opportunity to minimize these risks by modifying antiretroviral therapy during cancer treatment.”
Dr. Reid also notes: “Another major area of concern oncology providers have in managing cancers in people living with HIV involves risk of infectious complications. The guidelines address infection prophylaxis considerations, including specific recommendations for PLWH receiving cancer therapy for whom profound immunosuppression/
“Treating people living with HIV for cancer is a relatively new concern. It’s both a testament to the successes of HIV treatments in recent years, and a reminder that the quest for healthier outcomes is ongoing,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “That’s why at NCCN we are always seeking new ways to expand and update the resources that we offer.”
The NCCN Guidelines Panel for Cancer in People Living With HIV included oncologists, radiologists, infectious disease specialists, surgical oncologists, pharmacists, and a patient advocate. The panel stressed the importance of increasing the number of PLWH who participate in clinical trials for cancer treatments. Clinicians working with PLWH who have cancer should use clinicaltrials.gov to help patients find appropriate trials.
The NCCN Guidelines for Cancer in People Living With HIV are available free of charge for non-commercial use online at NCCN.org. They can also be viewed via the Virtual Library of NCCN Guidelines mobile app for smartphones and tablets.
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About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.
The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.
Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.