Outcomes of cervical cancer among HIV-infected and HIV-uninfected women treated at the Brazilian National Institute of Cancer

Abstract

Objective We assessed mortality, treatment response, and relapse among HIV-infected and HIV-uninfected women with cervical cancer in Rio de Janeiro, Brazil. Design Cohort study of 87 HIV-infected and 336 HIV-uninfected women with cervical cancer. Methods Patients at the Brazilian National Institute of Cancer (2001–2013) were matched on age, calendar year of diagnosis, clinical stage, and tumor histology. Staging and treatment with surgery, radiotherapy, and/or chemotherapy followed international guidelines. We used a Markov model to assess responses to initial therapy, and Cox models for mortality and relapse after complete response. Results Among 234 deaths, most were from cancer (82% in HIV-infected vs. 93% in HIV-uninfected women); only 9% of HIV-infected women died from AIDS. HIV was not associated with mortality during initial follow-up but was associated more than 1–2 years after diagnosis (overall mortality: stage-adjusted hazard ratio [HR] 2.02, 95%CI 1.27–3.22; cancer-specific mortality: 4.35, 1.86–10.2). Among 222 patients treated with radiotherapy, HIV-infected had similar response rates to initial cancer therapy as HIV-uninfected women (HR 0.98, 95%CI 0.58–1.66). However, among women who were treated and had a complete response, HIV was associated with elevated risk of subsequent relapse (HR 3.60, 95%CI 1.86–6.98, adjusted for clinical stage). Conclusion Among women with cervical cancer, HIV infection was not associated with initial treatment response or early mortality, but relapse after attaining a complete response and late mortality were increased in those with HIV. These results point to a role for an intact immune system in control of residual tumor burden among treated cervical cancer patients.

Impact of Human Immunodeficiency Virus Infection on Survival and Acute Toxicities From Chemoradiation Therapy for Cervical Cancer Patients in a Limited-Resource Setting

“…Those studies estimated a 1.7- to 2.0-fold increased risk of death associated with HIV infection. There are, however, several key differences between our study and those prior studies that may explain our discordant findings (16, 17, 28). In contrast to our study in which only women being treated with curative CRT were included, the 3 previous studies included women being treated with both palliative and curative intent.…”

“…However, our findings are discordant with results from a previous study in Botswana by Dryden-Peterson et al (17) (2016), from an analysis of administrative datasets of women in the United States with cervical cancer by Coghill et al (16) (2015), and from a retrospective study in Brazil by Ferreira et al (28) (2017). Those studies estimated a 1.7- to 2.0-fold increased risk of death associated with HIV infection.…”

Outcomes after Radiation Therapy for HIV Positive Patients with Invasive Cervical Cancer

“…For the CRT part, the median dose given to the pelvis was 45 Gy, dose similar to those recommended (Simonds et al, 2012, Simonds et al, 2015, Ferreira et al, 2017, Shrivastava et al, 2005 but the median EqD2 dose received by the cervical tumor, taking into account brachytherapy or the centro-pelvic boost was only 59.7 Gy. This dose is lower than the dose of 68 Gy considered adequate after CRT and brachytherapy (Simonds et al, 2012, Simonds et al, 2015.…”

“…Another limitation of our study is the low number of included patients. We studied 28 patients while the main series published included between 36 and 87 patients (Simonds, Wright, du Toit, Neugut & Jacobson, 2012, Simonds, Neugut & Jacobson, 2015, Ferreira et al, 2017, Shrivastava, Engineer, Rajadhyaksha & Dinshaw, 2005 The four major studies have been carried out in developing countries where the incidence of CCU and HIV is higher than in France.…”

Evolving Paradigms in HIV Malignancies: Review of Ongoing Clinical Trials

“…28,29 Hematologic toxicity, particularly, often results in dose reductions or elimination of concurrent chemotherapy during RT. Future planned studies will examine the toxicities of outback carboplatin/taxol in ART-treated PLWH for 4 cycles after standard chemoRT for locally advanced cervical cancer.…”