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Anal Cancer Treatment Is Equally Effective for HIV Positive and HIV Negative People

HIV positive people with anal cancer can be treated according to standards of care for HIV negative people and achieve equally good outcomes, according to a French retrospective analysis published in the August 15, 2009 issue of Alimentary Pharmacology and Therapeutics.

As people with HIV live longer thanks to effective combination antiretroviral therapy (ART), the incidence of anal cancer has increased, and is now more than 100 times higher than that of the general population.

Some earlier studies suggested that HIV positive people with anal cancer had a poor prognosis relative to HIV negative individuals, but later research looking at patients with less advanced HIV disease and higher CD4 cell counts have produced more promising findings.

L. Abramowitz and colleagues compared the long-term outcomes of anal cancer in HIV positive and negative patients in the era of effective combination ART. The analysis included all patients with epidermoid anal cancer referred to 6 hospitals in France between 1998 and 2004.

Data from a total of 151 patients (44 HIV positive, 107 HIV negative) were reviewed retrospectively for a median 27 (range 16-44) months. The

HIV positive patients were younger on average (45 vs 62 years; P < 0.001) and were more likely to be male (100% vs 27%; P < 0.001) than those without HIV.

Results

• No significant differences were observed according to HIV status with regard to tumor stage, pelvic radiotherapy (radiation) doses, or concurrent chemotherapy.
• After chemotherapy and radiotherapy, similar numbers of HIV positive and HIV negative patients experienced severe (grade 3-4) toxicities.
• 82% of HIV positive patients and 75% of HIV negative patients achieved a complete response (not a significant difference).
• After 3 years of follow-up, overall survival rates were 85% and 84%, respectively (non-significant)
• Disease-free survival rates were 77% and 67%, respectively (again, non-significant).
• Duration of HIV infection, HIV viral load, and CD4 cell count had no effect on survival rates of HIV positive patients.

"The clinical outcome of HIV positive patients with epidermoid anal cancer is similar to that of HIV negative patients," the investigators concluded. "Therefore, the same therapeutic guidelines should be applied to both populations."

AP-HP, Hôpital Universitaire Bichat, Paris, France; AP-HP, Service de Santé Publique, Hôpital Henri Mondor, Université Paris, Créteil, France; Hôpital Leopold Bellan, Paris, France; Groupe Hôspitalier Diaconesse Croix Saint Simon, Paris, France; AP-HP, Hôpital Universitaire Saint Louis, Paris, France; AP-HP, Hôpital universitaire Ambroise Paré, Boulogne, France; AP-HP, Université Paris 12, France; CHU Henri Mondor Créteil, Créteil, France.

8/21/09

Reference

L Abramowitz, N Mathieu, F Roudot-Thoraval, and others. Epidermoid anal cancer prognosis comparison among HIV+ and HIV− patients. Alimentary Pharmacology and Therapeutics 30(4): 414-421. August 15, 2009.