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HIV-ASSOCIATED CANCERS Co-convened by AORTIC and NCI

Tracks
STREAM 1
Tuesday, November 9, 2021
3:00 PM - 4:30 PM
STREAM 1

Speaker

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Dr Maureen Joffe
Wits Health Consortium

SOUTH AFRICAN BREAST CANCER AND HIV OUTCOMES STUDY (SABCHO) -SUMMARY FINDINGS

Abstract

The South African Breast Cancer and HIV Outcomes Study (SABCHO) is a NCI-funded longitudinal cohort study of ≥3,500 South African women with breast cancer prospectively recruited and enrolled between 2015 and 2019 and diagnosed, treated and followed for survival outcomes at two academic hospital cancer centers in Johannesburg and three in urban and rural regions of Kwa-Zulu Natal. This collaboration between investigators from the Universities of Witwatersrand and KwaZulu-Natal (South Africa) and Columbia University (USA) is investigating the impact of HIV and other chronic comorbidities, sociodemographic and clinical factors associated with stage at breast cancer diagnosis, treatment adherence, response and tolerance and 5-year overall survival. To date the study has yielded 35 peer-reviewed articles, with several more in submission and has received 10 South African and International research grants

Summary findings:-
The median age at BC diagnosis was 55 years; most patients were black (78%), multimorbidity (MM) was highly prevalent among the cohort; (obesity 53%, hypertension 41% and HIV 22%) and more common in older women and those of higher socioeconomic status. MM also impacted first cancer treatments received in women with early stage disease.

HIV status was associated with younger age at diagnosis,
Black race, later stage at diagnosis and poorer pathological response to neoadjuvant chemotherapy. They also had a 49% increased risk of death from any cause, after accounting for differences in age, ethnicity, breast cancer stage, subtype, and treatments received (60% versus 71%, p<0.001; aHR: 1.49, 95% CI 1.22-1.83). HIV+ women with <50 viral load copies/ml and those with ≥50 viral load copies/ml had worse survival than HIV-uninfected patients. HR 1.35 (1.09-1.66) and 1.54 (1.20-2.0) respectively.

Our cohort findings were consistent with those observed in smaller cohorts from USA-based cancer registries. The growing population of WLWH are at especially high risk for poor breast cancer outcomes.

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Dr Robert Yarchoan
Nih/NCI/OHAM

TREATMENT OF KAPOSI SARCOMA WITH POMALIDOMIDE

Abstract

Kaposi sarcoma (KS) is a multicentric tumor that is often cutaneous but can also develop in visceral organs. It is caused by Kaposi sarcoma associated herpesvirus (KSHV), also known as human herpesvirus 8 (HHV-8). KS is most common in persons living with HIV (PLWH) but can also develop in HIV-uninfected individuals. The incidence of KS is very high in sub-Saharan Africa (SSA) and it is a common cause of morbidity and mortality. KS cannot be cured, and the goal of therapy is long-term control. Mild HIV-KS often responds to antiretroviral therapy (ART), but in many cases systemic therapy is needed. The most effective agents are paclitaxel and liposomal doxorubicin. However, these have acute and cumulative toxicities and can be challenging to administer in resource-limited settings. Pomalidomide (Pom) is an oral immunomodulatory derivative of thalidomide that was approved in 2013 in the US for multiple myeloma. Our group had previously shown that thalidomide has activity in KS. We initiated a trial of Pom, 5 mg daily for 21 days out of 28 day cycles, in 28 patients with HIV-associated (18 patients) or unassociated (10 patients) KS. Participants with HIV-KS received ART, and all received aspirin 81 mg/day and mitigation strategies to prevent pregnancy. The overall response rate was 71% (95% confidence interval 51-87%), and the median progression-free-survival was 10.2 months. The most common toxicities were hematologic. One patient discontinued for cutaneous vasculitis and two elected to come off for neuropsychiatric effects attributable to therapy, but overall, the regimen was generally well tolerated. Based on this study, Pom was approved by the US Food and Drug Administration for HIV-associated and HIV-negative KS in 2020. As an oral well-tolerated drug, it may be useful for KS in resource-limited settings; the US AIDS Malignancy Consortium has recently initiated a trial of Pom in SSA.
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Dr. Warren Phipps
Fred Hutchinson Cancer Research Center

Leveraging collaborative clinical trials to advance HIV-associated cancer research in Africa: The AIDS Malignancy Consortium

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Dr Mostafa Nokta
National Cancer Institute

Q&A

Dr Margaret Borok
University of Zimbabwe

Q&A


Facilitators

Margaret Borok
University of Zimbabwe

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Mostafa Nokta
National Cancer Institute

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