CURRENT ISSUES IN AIDS MALIGNANCY RESEARCH: A COMMUNITY PERSPECTIVE

Objectives: To assess the current state of research on and current treatments for AIDS-associated malignancies, and to recommend improvements. Methods: Current literature was reviewed and interviews were conducted with leading academic researchers, NIH administrators, industry representatives, clinicians, treating physicians, and patient advocacy groups. Discussion: The complete etiology and pathogenesis of AIDS-associated malignancies remain incompletely understood. The discovery of the Kapost's sarcoma-associated herpesvirus (KSHV) has led to a renewed interest in the basic science of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL). Combination antiretroviral therapy with potent protease inhibitors has been shown to increase the survival of people with AIDS(PWAs) and their effect on the epidemiology, prognosis and treatment of KS and NHL is unknown. Current therapy for KS results in only a PR rate of 30 to 70%, and single-agent liposomal anthracyclines and Taxol have apparently replaced ABV as the standard of care because of efficacy and toxicity. For NHL, the CR rate is close to 50% but with a significant rate of relapse. No published data exist on a standard regimen for relapsed NHL. Clinical trials evaluating new cytotoxic agents and pathogenesis based treatments, including MGBG, the camptothecins, monoclonal antibodies, immunotoxins, and anti-EBV strategies using adoptive immunotherapy for NHL are all in development. Conclusion: Intensified efforts are needed to elucidate the etiology and pathogenesis of AIDS-associated malignancies and to develop more effective treatments. The United States Public Health Service along with the National Cancer Institute (NCI) and the Office of AIDS Research(OAR) should convene a panel to recommend standard treatment practices and principles for KS and NHL. A greater awareness of and a willingness to participate in current and experimental AIDS malignancy treatment trials is needed on the part of primary care physicians and their patients. Better cooperation and collaboration between NCI cancer cooperative groups, AIDS clmical trial networks, the pharmaceutical and biotechnology industries is encouraged. Resources directed towards basic and clinical AIDS malignancy research should be increased.