New treatment strategies for HIV-positive cancer patients undergoing antiblastic chemotherapy

ABSTRACT

Introduction: The introduction of Highly Active Antiretroviral Therapy (HAART) into clinical practice has dramatically changed the outcome of HIV-infected patients by prolonging their survival. The increase in life expectancy has led to an increased risk of non-AIDS-related mortality and morbidity, including cardiovascular diseases, neurocognitive diseases, neuroendocrine dysfunctions and cancer.

Areas covered: The GICAT (Italian Cooperation Group on AIDS and Tumors) has demonstrated that patients who receive a multidisciplinary approach with the combination of anticancer agents (AC) and HAART can achieve better responses and survival rates than patients who receive AC alone. The first obstacle for the oncologist to plan treatment for cancer HIV-patients is the preliminary evaluation of drug-drug interactions between AC and HAART. Recent progress in pharmacogenomics could provide a new approach for personalized treatments. The rationale of this review is to summarize the existing data on the impact of HAART on the clinical management of cancer patients with HIV/AIDS and DDIs between antiretrovirals and AC. In addition, to maximize the efficacy of both concomitant therapy and to minimize the risk of DDIs, a currently useful list of pharmacogenomic markers of key metabolic enzymes is provided.

Expert opinion: In this scenario, the importance of cooperation between oncologists and other health specialists (i.e., infectivologists, pharmacists, genetics and lab specialists) must not be underestimated in the management of these patients with the aim of planning an individual treatment strategy.

KEYWORDS:

• Drug metabolism
• pharmacogenomics
• pharmacogenetics
• cytochrome P450
• cancer
• AIDS
• individualized therapy

Article highlights

• Among cancers recorded in HIV patients, it is possible to distinguish AIDS-defining cancers (ADCs), such as Kaposi’s sarcoma, non-Hodgkin’s lymphoma (NHL) and invasive cervical cancer, and non-AIDS-defining cancers (NADCs), including hepatocellular carcinoma (HCC), anal cancer, lung cancer, colorectal cancer (CRC), gastrointestinal cancer (GI), breast cancer and Hodgkin’s lymphoma (HL). Here, we reviewed in detail the most recent data on NDACs.

• The first obstacle for the oncologist to plan treatment for cancer in HIV-patients is the preliminary evaluation of drug-drug interactions between AC and HAART. Recent progress in pharmacogenomic fields could provide a new approach for personalized therapy.

• The same adverse drug reaction related to HAART/AC combined treatment could be predicted through genetic polymorphisms known to be involved in their biotransformation.

• The pharmacogenetic testing for polymorphisms in CYP450 genes could help the oncologist in stratifying patients who are most likely to have a better outcome with HAART/AC (Table 1).

• Even if there is a clinical utility for the detection of CYP450 polymorphisms involved in HAART-based therapy, whether pharmacogenomics testing improves clinical outcomes is still an open question.

• To maximize the clinical management of HIV in cancer patients, the importance of cooperation between oncologists and other health specialists (i.e., infectious disease, pharmacogenetic and lab specialists) must not be underestimated.

This box summarizes key points contained in the article.

Acknowledgments

The authors would like to thank Favetta Paola, National Cancer Institute, Aviano (PN), Italy, for providing editorial assistance.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.