Annals of Oncology Advance Access originally published online on November 15, 2005
Annals of Oncology 2006 17(4):721-722; doi:10.1093/annonc/mdj061
© 2005 European Society for Medical Oncology
letter to the editor |
Oxaliplatin-based chemotherapy in association with highly active antiretroviral therapy in metastatic colorectal cancer HIV-infected patients
The introduction of highly active antiretroviral therapy (HAART) had a dramatic impact on the morbidity and mortality of human immunodeficiency virus (HIV)-infected patients with a decline in the incidence of several opportunistic infections, as well as of acquired immunodeficiency syndrome (AIDS)-defining malignancies [1
]. On the other hand, due to the prolonged life expectancy and the ageing of the HIV-positive population, tumours are now the major cause of death [2] and among them colorectal cancers constitute a significant fraction of all cancers.
Oxaliplatin is an antineoplastic agent currently indicated for use with fluorouracil and leucovorin for the treatment of advanced colorectal cancer (CRC) [3]. The feasibility and efficacy of concomitant oxaliplatin and HAART is still unknown in patients with HIV infection and metastatic CRC. Up to now, there are no published data on treatment patterns, response to therapy, or survival in this patient population.
Five consecutive patients with HIV infection and metastatic CRC were treated at the National Cancer Institute of Aviano (Italy), within the activities of the GICAT (Gruppo Italiano Cooperativo AIDS e Tumori) group from October 2002 to October 2004 with FOLFOX-4 [4] regimen and concomitant HAART.
Before treatment, patients were staged by means of physical examinations, complete blood cell count (including CD4 cell count), blood chemistry, HIV viral load, serum carcinoembryonic antigen analysis (CEA), computed tomography of the thorax, abdomen, and pelvis and ECG. HAART was given concomitantly from the beginning of chemotherapy, regardless of CD4 cell count and HIV viral load, and it was selected on the basis of the patient's prior antiretroviral exposure. After every cycle of chemotherapy filgrastim (300 mg/day s.c., from day 5 to complete haematological recovery) was profilactically administered.
The characteristics of the patients, the response to the FOLFOX-4 and the toxicities are shown in Table 1. Recycling was not performed at the scheduled time in four patients for haematological and gastrointestinal toxicities, but no patient was admitted to hospital because of severe toxicity or opportunistic infection. There was no apparent interaction between oxaliplatin and concomitant HAART administration. Complete remission (CR) was observed in one patient, while partial remission and progression disease occurred in three and one patients, respectively.
|
Two patients are still alive. One of them is in CR after 17 months due to a multidisciplinary approach, including liver resection of metastases.
In conclusion, these data demonstrated that FOLFOX-4 regimen with concomitant HAART is feasible and active, while the HIV infection is not a limiting factor for its use. Moreover, the concomitant use of HAART does not seem to increase the toxicity of the FOLFOX-4 regimen.
1 Division of Medical Oncology A and 2 Division of Gastroenterology, National Cancer Institute, Centro di Riferimento Oncologico, Aviano, Italy
* (E-mail: oma{at}cro.it; mberretta{at}cro.it)
References
1. Cooley TP. Non-AIDS-defining cancer in HIV-infected people. Hematol Oncol Clin N Am 2003; 17: 889–899.[CrossRef][ISI][Medline]
2. Bonnet F, Lewden C, May T et al. Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy. Cancer 2004; 101: 317–324.[CrossRef][ISI][Medline]
3. Cerosimo RJ. Oxaliplatin-associated neuropathy: a review. Ann Pharmacother 2005; 39: 128–135.
4. Andre T, Bensmaine MA, Louvet C et al. Multicenter phase II study of bimonthly high dose leucovorin, fluorouracil infusion, and oxaliplatin for metastatic colorectal cancer resistant to the same leucovorin and fluorouracil regimen. J Clin Oncol 1999; 17: 3560–3568.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||