Patients with breast cancer and HIV are more likely to receive suboptimal adjuvant chemotherapy than breast cancer patients without HIV, according to a study published today. JAMA network open.
With the introduction of antiretroviral therapy (ART), life expectancy for people with HIV in the United States increased from 10.5 years in 1996 to 28.9 years in 2011. As a result, as of 2016, 58% of HIV patients are over the age of 45. Researchers noted that older people with HIV are at risk for cancers that do not define AIDS.
Specifically, women living with HIV (WLHIV) are not at increased risk of developing breast cancer, but once diagnosed with HIV, cancer-specific mortality (HR, 1.85–2.64) and overall mortality (HR) are has been shown to be significantly worse. , 1.85). They explained that the factors contributing to these mortality rates are unknown. To this end, researchers will assess the association between HIV infection and her two quality of care indicators, relative dose intensity (RDI) of neoadjuvant and adjuvant chemotherapy and time to treatment initiation. conducted research.
Efforts to study the quality of cancer care among WLHIV are limited because relatively few patients with both diagnoses are treated at individual cancer centers. To overcome this challenge, researchers will combine retrospective data from his three metropolitan cancer centers: Sylvester Comprehensive Cancer Center, University of Pennsylvania Abramson Cancer Center, and Herbert Irving Comprehensive Cancer Center. We investigated the association between HIV comorbidities and breast cancer treatment.
Researchers studied women aged 18 and older with confirmed HIV infection before or at the same time as stage I-III breast cancer diagnosis between January 1, 2000 and December 31, 2018. Eligible patients were found by searching the cancer center’s electronic medical records. They then used tumor registry data to identify for each HIV-infected patient her two patients with breast cancer but not HIV infection to create a control group. The researchers also identified subcohorts of patients from both groups who received initial neoadjuvant chemotherapy or adjuvant chemotherapy for breast cancer at registered study sites.
Woman with breast cancer | Woman with breast cancer Image credit: Vasyl – Stock.adobe.com
The study population consisted of 66 women with breast cancer and HIV, including 38 (57.6%) from Sylvester Comprehensive Cancer Center, 17 (25.8%) from Abramson Cancer Center of Pennsylvania, and 11 (16.7%) from Abramson Cancer Center of Pennsylvania. %) were at the Herbert Irving Comprehensive Cancer Center. . Conversely, the control group consisted of her 132 patients who had breast cancer but were not infected with her HIV.
The researchers noted that WLHIV at the time of breast cancer diagnosis were slightly younger than matched controls (median age 51.1 years). [IQR, 45.7-58.2 years] vs. 53.9 years [IQR, 47.0-62.5 years]). Also, a higher proportion of WLHIV were non-Hispanic black than matched controls (65.2% vs. 19.7%).
WLHIV patients waited a median of 48.5 days (IQR, 32.0 to 67.0 days) from diagnosis to first breast cancer treatment, whereas HIV-uninfected individuals waited a median of 42.5 days (IQR, 25.0 to 59.0 days; unadjusted HR, 0.73; 95% CI) I waited. , 0.54-0.99). After adjusting for differences in race/ethnicity, grade, stage, receipt of initial surgery, and year of cancer diagnosis, researchers found no significant association between WLHIV and longer time to initiation of breast cancer treatment (HR , 0.78, 95% CI, 0.55). -1.12). Nevertheless, non-Hispanic black patients (HR, 0.50; 95% CI, 0.33-0.77) and Hispanic patients (HR, 0.67; 95% CI, 0.45-0.99) were still associated with delayed treatment initiation. Ta.
In addition, the chemotherapy subcohort consisted of 36 WLHIV and 62 HIV-uninfected women. The researchers found that fewer WLHIV were treated with taxanes than patients without HIV (83.3% vs. 98.4%). Additionally, the overall median chemotherapy RDI was as follows for patients with WLHIV (median, 0.87; IQR, 0.74 to 0.97) and for patients without HIV (median, 0.96; IQR, 0.88 to 1.00; median, 0.87). , IQR, 0.74-0.97). P = .01). The proportion of patients with an overall RDI of 0.85 or higher was also lower in WLHIV (58.3% vs. 82.3%; P = .02), grade 3 or higher neutropenia during chemotherapy occurred more frequently in WLHIV-infected individuals (36.1%) than in those without HIV (8.6%).
The researchers acknowledged the study’s limitations, including the small number of study subjects. Other limitations include the possibility of instances of missing data and some data errors resulting from manual data extraction. The researchers explained that these limitations were caused by the retrospective nature of the study and the need to pool data from diverse medical record systems to study rare populations. Despite these limitations, the researchers noted that the association between HIV infection and chemotherapy resistance reached statistical significance.
The authors concluded that “dose-limiting toxic effects and suboptimal uptake of neoadjuvant and adjuvant chemotherapy in breast cancer patients with concomitant HIV infection are significant in this group compared with other women with breast cancer.” “This may be a contributing factor to the well-documented increased risk of death.” “Co-infection with HIV may also limit the ability to safely implement other toxic but effective breast cancer treatments. To improve outcomes in this growing population, We need strategies to better support breast cancer patients living with HIV.”
reference
O’Neill DS, Marty YM, Crews KD, et al. Relative dose intensity of cancer treatment and time to chemotherapy in breast cancer patients living with HIV. JAMA net open. 2023;6(12):e2346223. doi:10.1001/jamanetworkopen.2023.46223
