“HIV status alone should not be used for cancer treatment decision-making,” emphasized Gita Suneja, MD, MSHP, Associate Professor of Radiation Oncology and Global Health, Duke University School of Medicine, and Co-Chair of the NCCN Guidelines Panel for Cancer in People Living With HIV. According to the NCCN Guidelines, this patient population, for whom cancer is now a leading cause of death, should receive cancer treatment per standard guidelines, although modifications in antiretroviral therapy (ART) may be needed. Although Dr. Suneja admitted that HIV management during cancer therapy poses many clinical challenges, “Appropriate cancer treatment can successfully be delivered especially when oncologists and HIV specialists work together to optimize care for both diseases.”
Dr. Suneja acknowledged a knowledge deficit surrounding the treatment of cancer in patients with HIV, with 70% of surveyed oncologists stating that sufficient guidelines were not currently available for treating this population.1 Consequently, guidance for practicing clinicians on how to manage patients with both cancer and HIV infection was sorely needed, thus the inaugural NCCN Guidelines were developed.
Treating patients with cancer who are HIV-positive is complex and requires input from multiple clinicians. Dr. Suneja referenced a survey of 500 medical and radiation oncologists across the United States,1 which found that “20% to 25% said they would not offer standard cancer therapy to people living with HIV,…[yet] 45% said they rarely or never discussed a management plan with an HIV specialist.”
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Robbins HA, Pfeiffer RM, Shiels MS. Excess cancers among HIV-infected people in the United States. J Natl Cancer Inst 2015;107:pii: dju503.
Suneja G, Shiels MS, Melville SK. Disparities in the treatment and outcomes of lung cancer among HIV-infected individuals. AIDS 2013;27:459–468.
Uldrick TS, Ison G, Rudek MA. Modernizing clinical trial eligibility criteria: recommendations of the American Society of Clinical Oncology-Friends of Cancer Research HIV Working Group. J Clin Oncol 2017;35:3774–3780.
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