Feasibility and Outcome of Routine Use of Concurrent Chemoradiation in HIV-positive Patients with Squamous Cell Anal Cancer

Andrew J. Leiker, Chiachien J. Wang, Nina N. Sanford, Todd A. Aguilera, Sirisha Karri, Muhammad S. Beg, Syed A. Kazmi, Craig Olson, Joselin A. Matthews, Abier Abdelnaby, Jeffrey J. Meyer, Michael R. Folkert

Research output: Contribution to journalArticle

Abstract

Objectives:Clinical concerns about hematologic toxicities in human immunodeficiency virus (HIV)+ patients with squamous cell anal cancer (SCAC) may lead to de-escalation of treatment intensity. The objective of this study is to evaluate clinical outcomes including toxicity following standard concurrent curative-intent chemoradiation for HIV+ and HIV-patients with SCAC.Materials and Methods:Among 97 evaluable patients treated between 2009 and 2016 (median age 52.2 y), 43 (44.3%) were HIV+ and 54 (55.7%) HIV-. The majority of the radiation was delivered using intensity-modulated radiation therapy and chemotherapy consisting primarily (93%) of 5-fluorouracil and mitomycin C. Clinical outcomes assessed included toxicity, locoregional control (LRC), distant metastasis (DM), progression-free survival (PFS), colostomy-free survival (CFS), overall survival (OS), and cause-specific survival (CSS).Results:With a median follow-up of 45 months, HIV+ patients exhibited a trend toward reduced OS compared with HIV-patients (4 y OS 61.2% vs. 78.3%; HR 2.09; 95% CI, 0.97-4.52; P=0.055) on univariable analysis, but HIV status was not significant after adjusting for additional parameters on multivariable analysis. Toxicity rates, LRC, CFS, PFS, freedom from DM, and CSS were similar between the 2 cohorts. On multivariable analysis, tumor size >5 cm impacted all clinical outcomes (trend for LRC) except CFS. Radiation treatment extension beyond 7 days was found to negatively impact LRC and CSS. Male sex was associated with worse CFS.Conclusions:Radiation therapy with concurrent 5-fluorouracil and mitomycin C chemotherapy is reasonably well-tolerated as curative treatment for HIV+ patients with SCAC, and no significant difference in outcomes was noted relative to HIV-patients.

Original languageEnglish (US)
Pages (from-to)701-708
Number of pages8
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume43
Issue number10
DOIs
StatePublished - Oct 1 2020

Keywords

  • anal cancer
  • concurrent chemoradiation
  • human immunodeficiency virus (HIV)

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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