HIV-associated germ cell cancer outcomes better in combination ART era
medwireNews: Men with HIV-associated germ cell cancer (HIV-GCC) have similar long-term survival outcomes to HIV-negative men with GCC, show results from an international collaborative study.
Therefore, “patients with HIV-GCC should remain on cART [combination antiretroviral therapy] and be managed identically to HIV-negative patients,” write Marcus Hentrich (University of Munich, Germany) and co-authors in Cancer.
Hentrich and team reviewed data for 89 men (median age 36 years) with HIV-GCC diagnosed at 23 institutions in six countries between 1996 and 2018. Approximately half (49%) of these cases were stage I disease and the remainder were stage II or III primary disseminated disease typically (78%) with good prognosis according to the International Germ Cell Cancer Collaborative Group criteria.
The participants had a median of 5 years between their first positive HIV test and GCC diagnosis, at which point their median CD4+ T-cell count was 420 cells/µL and 83% were either currently receiving or had previously received cART.
In terms of treatment, all of the men with stage I disease underwent orchiectomy. Half of them were then followed by active surveillance and a quarter received adjuvant chemotherapy or radiotherapy.
The majority (85%) of the 46 stage II or III GCCs (including one metachronous bilateral case) were treated with cisplatin-based chemotherapy, while 13% received radiotherapy for stage IIA/B seminoma, and 2% underwent primary retroperitoneal lymph node dissection for stage IIA nonseminoma.
The researchers report that median CD4+ T-cell counts did not change significantly before and after chemotherapy (454 vs 441 cells/μL) but did fall following radiotherapy (480 vs 223 cells/μL).
During a median 6.5 years of follow-up, 17% of patients experienced GCC relapse and 13% died as a result of refractory GCC (n=5), an AIDS-defining illness (n=3), or other causes (n=4).
This gave progression-free survival (PFS) rates of 81% at 5 years and 73% at 10 years, with corresponding overall survival (OS) rates of 91% and 85%.
Hentrich et al note that 5-year OS rate of 91% “is markedly better” the 2-year OS rates of 81% and 62% reported in two studies that predated cART. These earlier studies also found that the mortality rate from HIV/AIDS was 20%, compared with just 3% in the current study.
Therefore, “[e]ffective cART with a preserved or reconstituted immune system at the GCC diagnosis and thereafter may have greatly contributed to the better outcomes in our study,” the investigators remark.
They also comment that the 5-year OS rate they observed was “in line with the 5-year relative survival rates of 94% and 89% reported for HIV-negative men with testis cancer in Europe diagnosed from 1995 to 1999 and from 2000 to 2007, respectively.”
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