Abstract P6-11-17: Breast cancer in HIV patients: Characteristics and treatment course in a Washington DC based population
Authors: Kango Ghazal H. , Elkon Jacob M , Thebo Umera , Haroun Faysal 
Published: March 2020

Background: There is limited information on the effect of HIV or HAART therapy on breast cancer biology, treatment and outcomes as trials have often excluded this population.

Purpose: To evaluate the clinical course of persons living with HIV who develop breast cancer (BC) in terms of hormone receptor status, chosen treatment regimens, adverse events associated with chemotherapy, and HIV parameters such as CD4 count and VL.

Methods: Patients were searched retrospectively by billing codes for a diagnosis of HIV and BC from the years 2008-2018. Exclusion criteria included patients diagnosed with benign breast lesions (7 patients), incorrect breast cancer or HIV diagnosis (5), and patients without records of oncologic treatment (5); this resulted in 16/28 total patients. A database was generated to evaluate the patients’ baseline demographics, pathology, BC stage, treatment modalities, baseline lab parameters (creatinine, AST, ALT, CBC, CD4, viral load) at diagnosis and yearly after, adverse events (AE), and outcomes.

Results: The population were all were black and 15/16 were female. The age range was 35-70 with median of 56. All of the HIV diagnoses were made prior to their BC and 14/16 patients were on HAART therapy prior to chemotherapy. Twelve out of the sixteen patients received chemotherapy. Information regarding cancer characteristics and treatments is in Table 1.

Lab values were monitored from initial diagnosis and yearly thereafter. There were no significant changes in creatinine amongst the patients. (as defined as an increase of 0.3 or greater in the absence of ESRD). Two patients were ESRD prior to their cancer diagnosis and none of the patients had an initial diagnosis of CKD. There were no clinically significant changes in the AST and ALT values for the patients (defined as 3x the upper limit of normal). In terms of WBC, there was inadequate information for 2/16 patients to assess. Of the remaining 12 patients, four developed leukopenia (WBC&lt;4) none developed neutropenia (ANC &lt;500). One case was thought to be secondary to sepsis. In terms of hemoglobin, 3 patients developed a hemoglobin drop to less than 10. Only 1/16 patients developed thrombocytopenia (plt&lt;150), also in the setting of sepsis. 12/16 patents had HIV status monitored (CD4 and VL) during follow up. In this subset, none of the patients developed a significant drop in the CD4 count (CD4&lt; 400) and 3 patients had an improvement in VL to undetectable levels.

Finally, chemotherapy related major AEs were monitored for the 12 patients that received chemotherapy. The following AEs were considered major: hospitalization, nausea/vomiting or mucositis resulting in dose reduction, grade 2+ CIPN, and prolonged or adverse events from pancytopenia. Four patients were hospitalized for AEs, three of which received TCHP chemotherapy. Most admissions were due to severe nausea, vomiting and mucositis. Only one was admitted for subdural hematoma exacerbated by chemo-induced pancytopenia. The same patient had grade 3 CIPN. One patient developed a major AE of grade 3 CIPN likely secondary to Paclitaxel.

Conclusion: Results suggest that chemotherapy for BC in persons living with HIV appears to be feasible and safe. In addition, the rates of TNBC in this small sample size appear to be low compared to expected rates in AA. That said, larger cohorts are needed to further our understanding of any disparities in the biology and outcomes of breast cancer in patient with HIV.

Table 1. Selected characteristics of patient population.CharacteristicNumber of Patients (Percentages)ER positive2/16 (12.5%)ER and PR positive8/16 (50%)ER and PR and HER2 positive2/16 (12.5%)HER-2 positive1/16 (6.25%)Triple Negative2/16 (12.5%)ER and HER2 positive1/16 (6.25%)Cancer Stage I-II11/16 (68.75%)Cancer Stage III-IV5/16 (31.25%)Chemotherapy Regimens:12/16 (75%)TCH-P5/16 (31.25%)AC and Paclitaxel4/16 (25%)Paclitaxel-based2/16 (12.5%)Palboclicib1/16 (6.25%)

Citation Format: Ghazal H. Kango, Jacob M Elkon, Umera Thebo, Faysal Haroun. Breast cancer in HIV patients: Characteristics and treatment course in a Washington DC based population [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-17.