Outcomes of men with HIV and germ cell cancer: Results from an international collaborative study.
AIDS
HIV
HIV-related germ cell cancer
germ cell cancer
nonseminoma
seminoma
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
15 Jan 2022
15 Jan 2022
Historique:
revised:
08
08
2021
received:
06
06
2021
accepted:
09
08
2021
pubmed:
1
10
2021
medline:
11
3
2022
entrez:
30
9
2021
Statut:
ppublish
Résumé
Previous studies have shown that men with HIV and germ cell cancer (HIV-GCC) have inferior overall survival (OS) in comparison with their HIV-negative counterparts. However, little information is available on treatments and outcomes of HIV-GCC in the era of combination antiretroviral therapy (cART). This study examined men living with HIV who were 18 years old or older and had a diagnosis of histologically proven germ cell cancer (GCC). The primary outcomes were OS and progression-free survival (PFS). Data for 89 men with a total of 92 HIV-GCCs (2 synchronous GCCs and 1 metachronous bilateral GCC) were analyzed; among them were 64 seminomas (70%) and 28 nonseminomas (30%). The median age was 36 years, the median CD4 T-cell count at GCC diagnosis was 420 cells/µL, and 77% of the patients on cART had an HIV RNA load < 500 copies/mL. Stage I disease was found in 44 of 79 gonadal GCCs (56%). Among 45 cases with primary disseminated GCC, 78%, 18%, and 4% were assigned to the good-, intermediate-, and poor-prognosis groups, respectively, of the International Germ Cell Cancer Collaborative Group. Relapses occurred in 14 patients. Overall, 12 of 89 patients (13%) died. The causes of death were refractory GCC (n = 5), an AIDS-defining illness (n = 3), and other causes (n = 4). After a median follow-up of 6.5 years, the 5- and 10-year PFS rates were 81% and 73%, respectively, and the 5- and 10-year OS rates were 91% and 85%, respectively. The 5- and 10-year PFS and OS rates of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients. Men living with HIV are at increased risk for germ cell cancer (GCC). Previous studies have shown that the survival of men with HIV-associated germ cell cancer (HIV-GCC) is poorer than the survival of their HIV-negative counterparts. This study examined the characteristics, treatments, and outcomes of 89 men with HIV-GCC in the era of effective combination antiretroviral therapies. The long-term outcomes of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients.
Sections du résumé
BACKGROUND
BACKGROUND
Previous studies have shown that men with HIV and germ cell cancer (HIV-GCC) have inferior overall survival (OS) in comparison with their HIV-negative counterparts. However, little information is available on treatments and outcomes of HIV-GCC in the era of combination antiretroviral therapy (cART).
METHODS
METHODS
This study examined men living with HIV who were 18 years old or older and had a diagnosis of histologically proven germ cell cancer (GCC). The primary outcomes were OS and progression-free survival (PFS).
RESULTS
RESULTS
Data for 89 men with a total of 92 HIV-GCCs (2 synchronous GCCs and 1 metachronous bilateral GCC) were analyzed; among them were 64 seminomas (70%) and 28 nonseminomas (30%). The median age was 36 years, the median CD4 T-cell count at GCC diagnosis was 420 cells/µL, and 77% of the patients on cART had an HIV RNA load < 500 copies/mL. Stage I disease was found in 44 of 79 gonadal GCCs (56%). Among 45 cases with primary disseminated GCC, 78%, 18%, and 4% were assigned to the good-, intermediate-, and poor-prognosis groups, respectively, of the International Germ Cell Cancer Collaborative Group. Relapses occurred in 14 patients. Overall, 12 of 89 patients (13%) died. The causes of death were refractory GCC (n = 5), an AIDS-defining illness (n = 3), and other causes (n = 4). After a median follow-up of 6.5 years, the 5- and 10-year PFS rates were 81% and 73%, respectively, and the 5- and 10-year OS rates were 91% and 85%, respectively.
CONCLUSIONS
CONCLUSIONS
The 5- and 10-year PFS and OS rates of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients.
LAY SUMMARY
BACKGROUND
Men living with HIV are at increased risk for germ cell cancer (GCC). Previous studies have shown that the survival of men with HIV-associated germ cell cancer (HIV-GCC) is poorer than the survival of their HIV-negative counterparts. This study examined the characteristics, treatments, and outcomes of 89 men with HIV-GCC in the era of effective combination antiretroviral therapies. The long-term outcomes of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
260-268Informations de copyright
© 2021 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.
Références
Adra N, Einhorn L. Testicular cancer update. Clin Adv Hematol Oncol. 2017;15:386-396.
Hentrich M, Pfister D. HIV-associated urogenital malignancies. Oncol Res Treat. 2017;40:106-112.
Hernández-Ramírez RU, Shiels MS, Dubrow R, Engels EA. Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study. Lancet HIV. 2017;4:e495-e504.
Hessol NA, Whittemore H, Vittinghoff E, et al. Incidence of first and second primary cancers diagnosed among people with HIV, 1985-2013: a population-based, registry linkage study. Lancet HIV. 2018;5:e647-e655.
Bower M, Palfreeman A, Alfa-Wali M, et al. British HIV Association guidelines for HIV-associated malignancies. HIV Med. 2014;15(suppl 2):1-92.
Timmerman JM, Northfelt DW, Small EJ. Malignant germ cell tumors in men infected with the human immunodeficiency virus: natural history and results of therapy. J Clin Oncol. 1995;13:1391-1397.
Bernardi D, Salvioni R, Vaccher E, et al. Testicular germ cell tumors and human immunodeficiency virus infection: a report of 26 cases. J Clin Oncol. 1995;13:2705-2711.
Hentrich MU, Brack NG, Schmid P, Schuster T, Clemm C, Hartenstein RC. Testicular germ cell tumors in patients with human immunodeficiency virus infection. Cancer. 1996;77:2109-2116.
Fizazi K, Amato R, Beuzeboc P, et al. Germ cell tumors in patients infected by the human immunodeficiency virus. Cancer. 2001;92:1460-1467.
Powles T, Bower M, Sharnash J, et al. Outcome of patients with HIV-related germ cell tumours: a case-control study. Br J Cancer. 2004;90:1526-1530.
Powles T, Bower M, Daugaard G, et al. Multicenter study of human immunodeficiency virus-related germ cell tumors. J Clin Oncol. 2003;21:1922-1927.
Sobin LH, Compton CC. TNM seventh edition: what's new, what's changed: communication from the International Union Against Cancer and the American Joint Committee on Cancer. Cancer. 2010;116:5336-5339.
International Germ Cell Cancer Collaborative Group. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancer. J Clin Oncol. 1997;15:594-603.
US Centers for Disease Control and Prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992;41:1-19.
Spina M, Jaeger U, Sparano JA, et al. Rituximab plus infusional cyclophosphamide, doxorubicin, and etoposide in HIV-associated non-Hodgkin lymphoma: pooled results from 3 phase 2 trials. Blood. 2005;105:1891-1897.
Bower M, Stebbing J, Tuthill M, et al. Immunologic recovery in survivors following chemotherapy for AIDS-related non-Hodgkin lymphoma. Blood. 2008;111:3986-3990.
Hentrich M, Berger M, Wyen C, et al. Stage-adapted treatment of HIV-associated Hodgkin lymphoma: results of a prospective multicenter study. J Clin Oncol. 2012;30:4117-4123.
Beyer J, Albers P, Altena R, et al. Maintaining success, reducing treatment burden, focussing on survivorship: highlights from the Third European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer. Ann Oncol. 2013;24:878-888.
Honecker F, Aparicio J, Berny D, et al. ESMO consensus conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol. 2018;29:1658-1686.
Sant M, Allemani C, Santaquilani M, Knijn A, Marchesi F, Capocaccia R. EUROCARE-4. Survival of cancer patients diagnosed in 1995-1999. Results and commentary. Eur J Cancer. 2009;45:931-991.
Trama A, Foschi R, Larrañaga N, et al. Survival of male genital cancers (prostate, testis and penis) in Europe 1999-2007: results from the EUROCARE-5 study. Eur J Cancer. 2015;51:2206-2216.
Kier MG, Lauritsen J, Mortensen MS, et al. Prognostic factors and treatment results after bleomycin, etoposide, and cisplatin in germ cell cancer: a population-based study. Eur Urol. 2017;71:290-298.
Daugaard G, Gundgaard MG, Mortensen MS, et al. Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort. J Clin Oncol. 2014;32:3817-3823.
Tandstad T, Ståhl O, Dahl O, et al. Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA). Ann Oncol. 2016;27:1299-1304.
Kollmannsberger C, Tandstad T, Bedard PL, et al. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol. 2015;33:51-57.
Cullen M, Huddart R, Joffe J, et al. The 111 study: a single-arm, phase 3 trial evaluating one cycle of bleomycin, etoposide, and cisplatin as adjuvant chemotherapy in high-risk, stage 1 nonseminomatous or combined germ cell tumours of the testis. Eur Urol. 2020;77:344-351.
Fankhauser CD, Sander S, Roth L, Beyer J, Hermanns T. Improved survival in metastatic germ-cell cancer. Ann Oncol. 2018;29:347-351.
Hentrich M, Debole J, Jurinovic V, Gerl A. Improved outcomes in metastatic germ cell cancer: results from a large cohort study. J Cancer Res Clin Oncol. 2021;147:533-538.
Beyer J, Collette L, Sauvé N, et al. Survival and new prognosticators in metastatic seminomas: results from the IGCCCG-Update Consortium. J Clin Oncol. 2021;39:1553-1562.
Gillessen S, Sauvé N, Collette L, et al. Predicting outcomes in men with metastatic nonseminomatous germ cell tumors (NSGCT): results from the IGCCCG Update Consortium. J Clin Oncol. 2021;39:1563-1574.