NCCN Establishes Guidelines for Treating People With HIV and Cancer

People living with HIV have an estimated 50 percent increased rate of also being diagnosed with cancer, yet this population still faces barriers to care, with many of individuals not getting proper cancer treatment.

So, a team of health care providers, patients and advocates gathered to create new National Comprehensive Cancer Network (NCCN) treatment guidelines for people living with HIV who also have cancer. The guidelines focus on the collaboration between the patient, their cancer care team and HIV specialists to ensure that they get safe and appropriate treatment.

“Historically, people with HIV had trouble getting competent cancer treatment,” Jeff Taylor, from the Patient Advocate for the NCCN Guidelines Panel on Cancer in People Living with HIV, said in an interview with CURE.

For Taylor, the issue hits home. He is living with HIV and was diagnosed with anal cancer — a common cancer type for people with HIV – about two decades ago.

Other common types of cancer for people with HIV include non-Hodgkin lymphoma, Kaposi sarcoma, lung cancer, prostate cancer, liver cancer, colorectal cancer, Hodgkin lymphoma, oral/pharyngeal cancer, female breast cancer and cervical cancer.

Taylor said that some physicians are concerned with drug-drug interactions between many cancer treatments and some of the agents that were previously used to treat HIV.

But the treatment of HIV has drastically changed since AZT (zidovudine) became the first drug approved to treat HIV more than three decades ago. Modern antriretroviral therapy (ART) is allowing people in this population to live longer, healthier lives.

“Hopefully the word will get out that the drug-drug interactions weren’t what they used to be,” Taylor said, mentioning that newer, “cleaner” drugs are now widely used.

But still, the guidelines emphasized that it is important for oncologists, HIV clinicians and pharmacists to work together to ensure safe and effective treatment, as some drug interactions can still cause an increase in toxicity. However, these risks can be minimized by modifying ART during cancer treatment.

And since the new guidelines strongly advocate for a multidisciplinary health care team, including oncologists, radiologists, infectious disease specialists, surgical oncologists and pharmacists, advocates and physicians alike are hoping that they result in more people with HIV getting the cancer treatment they need — be it in a cancer clinic or in a clinical trial.

“One main takeaway from the guideline is that HIV status alone should not be used for cancer treatment decision-making,” Gita Suneja, M.D., from the Duke Cancer Institute and co-chair of the NCCN Guidelines Panel for Cancer in People Living With HIV, said in an interview with CURE. “Another major takeaway is that cancer patients living with HIV should be co-managed by an oncologist and an HIV specialist. This requires deliberate communication to ensure that both HIV and cancer are treated optimally.”