NCCN: New Guidelines on Care of HIV Concurrent With Cancer

The National Comprehensive Cancer Network (NCCN) has released new NCCN Clinical Practice Guidelines in Oncology that emphasize theimportance of treating people living with HIV who are diagnosed with cancer. A key part of treatment for these patients is collaboration between an oncologist and an HIV specialist.

In 2017, it was estimated that more than 1.1 million people in the United States are living with HIV, and an estimated 7,760 were diagnosed with cancer. People living with HIV are 50% more likely to be diagnosed with cancer than the general population. Among the most commonly occurring cancers in this population are non-Hodgkin lymphoma, oral/pharyngeal cancer, breast cancer, cervical cancer, Kaposi sarcoma, lung cancer, anal cancer, prostate cancer, liver cancer, colorectal cancer, and Hodgkin lymphoma.

Despite this higher incidence of comorbid cancers, studies have shown that people living with HIV are less likely to be treated for their cancer, compared with HIV-negative people who have cancer.

“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, from Duke Cancer Institute, Durham, North Carolina. 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 new guidelines contain several recommendations, including:

• Most people living with HIV should be offered the same cancer therapies as HIV-negative people.
• Modifications to cancer treatment should not be made solely based on a patient’s HIV status.
• Care for patients diagnosed with HIV should be co-managed with an oncologist and an HIV specialist.
• Prior to initiating cancer treatment of an HIV-positive patient, oncologists and HIV clinicians, along with pharmacists, should review proposed cancer therapy and antiretroviral therapy for possible drug-drug interactions and overlapping toxicity concerns.

In addition to these general recommendations, the guidelines also include recommendations regarding the management of specific cancer types in people living with HIV. Additional recommendations can also be found in the NCCN Guidelines for AIDS-Related Kaposi Sarcoma and as well as the AIDS-related B-cell lymphoma section of the NCCN Guidelines for B-cell Lymphomas.

“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.

Overall, data on the treatment of people living with HIV are limited. The guidelines stressed the importance of increasing the number of people living with HIV who are included in clinical trials for cancer treatments. To find clinical trials online at NCCN Member Institutions, visit nccn.org/clinical_trials/physician.html.