450 Safety of immune checkpoint inhibitors in cancer patients with HIV – real world outcomes

Background

The use of anti-retroviral therapy has improved the survival of patients with HIV infection, resulting in an increased incidence on non-AIDs defining malignancies Immune checkpoint inhibitors (ICI) have changed the landscape of oncologic treatment. However, HIV patients are excluded from most of the clinical trials, resulting in a knowledge gap regarding the safety and efficacy of ICI in these patients, leading to reluctance among clinicians to offer ICI treatment. This study aims to investigate the safety profile of ICI in HIV patients with diagnosis of malignancy.

Methods

We conducted a retrospective analysis of electronic health records from TriNetX Research Network (TriNetX LLC., Cambridge, Massachusetts, USA) to identify adult patients with HIV diagnosed with cancer, and who received ICI treatment. These included Anti-PD-1 (Cemiplimab, Nivolumab, or Pembrolizumab), Anti-PDL-1 (Atezolizumab, Avelumab, or Durvalumab) or anti-CTLA-4 (Ipilimumab). We recorded immune related adverse events (irAE) during the first year following ICI treatment, as irAE are rare after this period. The International Classification of Disease 10 Clinical Modification (ICD-10-CM) codes were used to identify skin toxicities, thyroid dysfunction, colitis, pneumonitis, and hepatitis. Patients with reported irAE before ICI use were excluded.

Results

A total of 844 patients were identified with age ranging from 25 to 88 years (mean 59.8). Of these, 27% were female. The most common malignancy diagnosis was lung cancer (n=418,50%) followed by melanoma and skin cancer(n=189,22%). The most common irAE was thyroid dysfunction (5.9%) followed by skin toxicity (4.25%) and immune colitis (3.04%). (Table 1).

Conclusions

Our study demonstrates that HIV patients who receive ICI treatment have similar risk of irAE compared to non-HIV patients, indicating that ICI treatment is safe in this population. Eligibility criteria for clinical trials should be expanded to include HIV patients to improve health outcomes in this population.