Immune Checkpoint Inhibitors Study for People Living With HIV Shows Promising Results

June 22, 2023

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Researchers and clinicians have been wary of treating people living with HIV with Keytruda, Opdivo and other immune checkpoint inhibitors because removing an inhibitory step in the immune response was seen as risky for people with compromised immune systems.

A new study looking at people living with HIV who were treated with immune checkpoint inhibitors for cancer has provided some interesting insights into the safety and efficacy of immunotherapy. The retrospective study had a cohort of approximately 400 people living with HIV and found no excess or unexpected treatment-related immune toxicities compared with historical and matched controls without HIV.

Talal El Zarif, M.D., and his colleagues investigated the use of immune checkpoint inhibitors drugs such as Keytruda (pembrolizumab) in people living with HIV.

The results were reported online ahead of print last month in the Journal of Clinical Oncology. Talal El Zarif, M.D., a research fellow in oncology at Dana-Farber Cancer Institute in Boston, was the first author of study.

“For me, I was interested in infectious diseases and oncology and I was looking for a nice project at the intersection of both and had been interested in studying the clinical outcomes of patients receiving immune therapy,” El Zarif said.

The immune checkpoint inhibitors include Keytruda (pembrolizumab), Opdivo (nivolumab), Tecentriq (atezolizumab) and Yervoy (ipilimumab).

El Zarif noted that those living with HIV have historically been excluded from clinical trials of immune checkpoint inhibitors because concerns about potential immune-related adverse events. In fact, as many as 74% of clinical trials involving immune checkpoint inhibitors excluded people living with HIV between 2019 and 2020.

However, his new study revealed that people living with HIV can receive the same standard of care as the general population.

“We thought that we could channel our effort and put it into studying this population to understand how immune checkpoint inhibitors are behaving in this population,” El Zarif said.

The retrospective study had a cohort of approximately 400 people living with HIV and found no excess or unexpected treatment-related immune toxicities compared with historical and matched controls without HIV.

The researchers analyzed 390 people from 33 different center living with HIV who had been treated with PD-1 or PD-L1 immunotherapy across 10 distinct cancer types, with various baseline CD4-positive T-cell counts and HIV viral loads. Keytruda and Opdivo are two of the mostly prescribed PD-1 inhibitors and Tecentriq and Imfinzi (durvalumab) are two of the most commonly prescribed PD-L1 inhibitors.

“One of the main questions was we wanted to look at the safety in terms of percentage of adverse events, and the key finding in the overall cohort was that patients who developed adverse events were about 20%,” El Zarif said.

Recorded objective response rates were 69% for nonmelanoma skin cancer, 31% for non–small cell lung cancer, 16% for hepatocellular carcinoma, and 11% for head and neck squamous cell carcinoma.

“When a patient walks into the clinic and they have cancer and you want to start a treatment plan but you stumble upon a diagnosis, this can be confusing for a clinician,” El Zarif said. “If a clinical sees someone with HIV and cancer and wants to give them an immune checkpoint inhibitors, it’s important they know they data out there. Our paper will be a very important resource on what to expect. That will make them more comfortable.”