Hepatocellular cancer therapy in patients with HIV infection: Disparities in cancer care,trials enrolment,and cancer-related research |
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Authors: | Francesca Negri Gabriele Missale Anna Degli Antoni Camillo Porta |
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Affiliation: | 1. Medical Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy;2. Unit of Infectious Diseases and Hepatology, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy;3. Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy;4. Chair of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari ‘A. Moro’, Piazza G. Cesare 11, 70124 Bari, Italy;5. Division of Medical Oncology, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Piazza G. Cesare 11, 70124 Bari, Italy |
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Abstract: | In the highly active antiretroviral therapy (HAART) era, hepatocellular carcinoma (HCC) is arising as a common late complication of human immunodeficiency virus (HIV) infection, with a great impact on morbidity and mortality. Though HIV infection alone may not be sufficient to promote hepatocarcinogenesis, the complex interaction of HIV with hepatitis is a main aspect influencing HCC morbidity and mortality.Data about sorafenib effectiveness and safety in HIV-infected patients are limited, particularly for patients who are on HAART. However, in properly selected subgroups, outcomes may be comparable to those of HIV-uninfected patients. Scarce data are available for those other systemic treatments, either tyrosine kinase inhibitors, as well as immune checkpoint inhibitors (ICIs), which have been added to our therapeutic armamentarium. This review examines the influence of HIV infection on HCC development and natural history, summarizes main data on systemic therapies, offers some insight into possible mechanisms of T cell exhaustion and reversal of HIV latency with ICIs and issues about clinical trials enrollment. Nowadays, routine exclusion of HIV-infected patients from clinical trial participation is totally inappropriate, since it leaves a number of patients deprived of life-prolonging therapies. |
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Keywords: | Human immunodeficiency virus Hepatocellular carcinoma Sorafenib Immunotherapy Clinical trial |
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