NCCN NewsMore People Living With HIV and Cancer Should Get Appropriate Cancer Treatment, According to New GuidelinesNCCN Engages Envision Pharma Group to Support Their Oncology Research Program Using iEnvision—A New Web-Based Software Platform for Medical ProgramsLeading Cancer Organizations Provide Guidance on Understanding and Managing Immunotherapy Side EffectsNCCN Reaches New Records for Guidelines, Resources, and Programs
Journal: Journal of the National Comprehensive Cancer Network (2018)

More People Living With HIV and Cancer Should Get Appropriate Cancer Treatment, According to New GuidelinesNCCN has released brand new NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) intended to help make sure people living with HIV (PLWH) who are diagnosed with cancer receive safe, necessary treatment.In 2010, an estimated 7,760 PLWH in the United States were diagnosed with cancer, representing an approximately 50% higher rate than the general population. 1 However, studies have found PLWH are treated for cancer at significantly lower rates than HIV-negative people with cancer, despite most treatment courses being safe and effective in this population. 2,3 "The disparity in cancer care is large and significant.For most cancers, PLWH are 2to 3-times more likely to receive no cancer treatment compared with uninfected people," said Gita Suneja, MD, Duke Cancer Institute.Dr. Suneja is Co-Chair of the NCCN Guidelines Panel for Cancer in PLWH."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." 4 The most common types of cancer occurring in PLWH are, in order of incidence: non-Hodgkin's lymphoma, Kaposi sarcoma, lung cancer, anal cancer, prostate cancer, liver cancer, colorectal cancer, Hodgkin lymphoma, oral/pharyngeal cancer, female breast cancer, and cervical cancer.The new NCCN Guidelines for Cancer in PLWH includes general advice-while highlighting the importance of working in collaboration with an HIV specialist-as well as specific treatment recommendations for non-small cell lung cancer, anal cancer, Hodgkin lymphoma, and cervical cancer.Additional recommendations can be found in the recently released NCCN Guidelines for AIDS-Related Kaposi Sarcoma as well as the AIDS-related B-cell lymphomas section of the NCCN Guidelines for B-Cell Lymphomas."The ultimate goal is to improve cancer survival among PLWH," said Dr. Suneja."With modern antiretroviral therapy (ART), PLWH are living longer and therefore getting more cancers related to both HIV infection and aging.The bottom line is that the cancer burden is growing-in fact, cancer is quickly becoming the leading cause of death in PLWH-so we urgently need to improve cancer treatment in this population."Among the recommendations found in the new NCCN Guidelines: • Most PLWH who develop cancer should be offered the same cancer therapies as HIV-negative individuals, and modifications to cancer treatment should not be made solely on the basis of HIV status.• Care for patients diagnosed with HIV should be comanaged with an oncologist and an HIV specialist (visit locator.hiv.gov to find local specialists in the United States).• Oncologists and HIV clinicians, along with HIV and oncology pharmacists, if available, should review proposed cancer therapy and ART for possible drug-drug interactions and overlapping toxicity concerns prior to initiation of therapy."One of the most important points we want providers to be aware of surrounds the potential for drug interactions and overlapping toxicities between cancer therapeutics and ART," said Erin Reid, MD, UC San Diego Moores Cancer Center.Dr. Reid is Co-Chair of the NCCN Guidelines Panel for Cancer in PLWH and Vice-Chair of the AIDS Malignancy Consortium Lymphoma Working Group."Some antiretroviral-cancer therapeutic combinations have serious risk of increased toxicity, although others may reduce levels of either cancer therapeutics or antiretrovirals.The good news is that with the expansion of antiretroviral combinations available, there is opportunity to minimize these risks by modifying ART during cancer treatment."Dr. Reid also notes: "Another major area of concern oncology providers have in managing cancers in PLWH involves risk of infectious complications.The guidelines Cont. on page xxvi.