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  P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

  • Event: WCLC 2019
  • Type: Poster Viewing in the Exhibit Hall
  • Track: Treatment in the Real World - Support, Survivorship, Systems Research
  • Presentations: 1
  • Now Available
  • Moderators:
  • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall

  • 31703

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    P2.16-21 - Effects of Molecular Markers on Responses, Relapses, and Survival in Lung Cancer Patients with HIV (Now Available) (ID 2038)

    10:15 - 18:15  |  Author(s): Chad Achenbach
    • Abstract
    • Slides

    Background
    

    Patients with HIV are aging due to potent combination antiretroviral therapy (ART) and the incidence of lung cancer has increased. Limited research has been performed on the relationship between HIV and lung cancer prognosis and recurrence. Based on previous data and our clinical experience, patients with HIV and lung cancer have worse prognosis¹ potentially due to social and behavioral risk factors, unfavorable molecular markers and differences in treatment patterns.

    Method
    

    We identified patients with HIV and lung cancer between January 1, 2001 and December 31, 2015 using Northwestern Medicine (NM) Electronic Data Warehouse (EDW). Lung cancer cases were verified and treatment/outcome information was extracted by chart review. We then compared the effects of molecular markers on treatment responses, relapses, and survival in lung cancer patients with HIV infection. Incidence and prognosis were compared to historical, non-HIV lung cancer controls.

    Result
    

    We included 36 individuals with HIV and lung cancer in this analysis. The median age at diagnosis was 55 years, 75.0% (27/36) were male, 94.0% (34/36) smokers.

    Histology:

    Small Cell – 1 (2.8%), Squamous cell – 10 (27.8%), Adenocarcinoma – 21 (58.3%), Other NSCLC – 2 (5.6%) Unreported – 2 (5.6%).

    Molecular:

    EGFR – 2 (5.6%), ROS1 – 0 (0%), ALK – 3 (8.3%), KRAS – 1 (2.8%), PDL1 – 2 (5.6%), Not Reported – 6 (16.7%).

    Stage at Diagnosis:

    Stage I – 3 (8.3%), Stage II – 6 (16.7%), Stage III – 2 (5.6%), Stage IV – 21 (58.3%), unreported – 4 (11.1%)

    Median survival – 2 years for all patients.

    EGFR – 1 year, ALK – 5.5 years, KRAS – 1 year, PDL1 – 1 year

    Conclusion
    

    In prior research, patients with HIV and lung cancer appear to have decreased survival with reported overall survival of 7 months compared to 25 months for historical controls irrespective of stage and stage appropriate treatment for lung cancer². In our study cohort, patients appeared to be treated similar to non-HIV controls, and the overall survival is fairly consistent with historic non-HIV controls, but smoking incidence (34/36; 94%) was higher than in non-HIV patients with lung cancer (85%). The prevalence of ALK translocation (3/36; 8%) was higher than typically observed among those without HIV (3-5%) and occurred exclusively in smokers. Typically, ALK translocation occurs in non-smokers. HIV patients treated with ALK inhibitors appeared to respond to similarly to non-HIV patients with NSCLC based on historic clinical data.

    Increased mortality in HIV, lung cancer patients is likely multifactorial, including concerns for lack of aggressive anti-cancer therapy delivered in this population. Our findings suggest that identifying driver mutations and molecular marker mutations may improve clinical practice for treatment of HIV-associated lung cancer. More prospective study is needed in this population.

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