Human Immunodeficiency Virus Infection and Non-small Cell Lung Cancer: Survival and Toxicity of Antineoplastic Chemotherapy in a Cohort Study

• DOI: 10.1097/jto.0b013e318217b6e0
• Publication Date: 2011-04-21T07:34:24Z
• Authors: Alain Makinson; Jean-Charles Tenon; Sabrina Eymard-Du...; Jean-Louis Pujol; Clotilde Allavena; Lise Cuzin; Isabelle Poizot-M...; Xavier de la Trib...; André Cabié; Pascal Pugliese; Jacques Reynes; Vincent Le Moing
• Keywords: Pulmonary and Respiratory Medicine; Adult; Male; HAART; Lung Neoplasms; Interaction; Anti-HIV Agents; Antineoplastic Agents; HIV Infections; NSCLC; 03 medical and health sciences; 0302 clinical medicine; Antiretroviral Therapy, Highly Active; Carcinoma, Non-Small-Cell Lung; Chemotherapy; Humans; Drug Interactions; Aged; Retrospective Studies; Toxicity; HIV; Middle Aged; Prognosis; Survival Analysis; Antiretroviral therapy; CD4 Lymphocyte Count; 3. Good health; CD4 lymphocytes; Treatment Outcome; Oncology; Female; France; Lung cancer

To describe factors associated with survival in human immunodeficiency virus (HIV)-infected subjects with non-small cell lung cancer (NSCLC) and analyze toxicities induced by cytotoxic chemotherapy and antiretroviral compounds.Retrospective analyses of HIV-infected subjects with NSCLC enrolled in the Dat'Aids cohort. A toxicity substudy included subjects treated by at least one cycle of cytotoxic chemotherapy.Survival was analyzed using Cox models. In the toxicity substudy, factors associated with grade 4 hematological toxicity of each episode of combination of antiretroviral drugs and cytotoxic chemotherapy were analyzed using marginal logistic regression models.Fifty-two subjects were included in the study: 42 were men, median age was 48 years, 98% were smokers, with a median of 30 pack years, median CD4 was 300 cells/μl, and median survival time was 12 months. CD4 levels ≥200 cells/μl at NSCLC diagnosis (hazard ratio [HR] = 0.29, 95% confidence interval [CI] [0.10-0.89]), performance status less than 2 (HR = 0.32, 95% CI [0.15-0.68]) and highly active antiretroviral therapy (HR = 0.26, 95% CI [0.09-0.74]) were significantly associated with increased survival in the multivariable model. Forty subjects were included in the toxicity substudy, and 14 among 68 different combinations were complicated by a grade 4 hematological toxicity. Protease inhibitor use (odds ratio = 5.22, 95% CI [1.07-25.38]) was significantly associated with grade 4 hematological toxicity in the multivariable analyses.In HIV-infected patients, CD4 levels at NSCLC diagnosis may be a predictive factor of survival. Use of highly active antiretroviral therapy during NSCLC chemotherapy is warranted, but protease inhibitors should be used with caution, as they may enhance severe hematological toxicities.