Assessment of the safety of nivolumab in people living with HIV with advanced cancer on antiretroviral therapy: the AIDS Malignancy Consortium 095 Study

• Published in: Cancer 2024-03, Vol.130 (6), p.985-994
• Main Authors: Rajdev, Lakshmi, Jackie Wang, Chia‐Ching, Joshi, Himanshu, Lensing, Shelly, Lee, Jeannette, Ramos, Juan Carlos, Baiocchi, Robert, Ratner, Lee, Rubinstein, Paul G., Ambinder, Richard, Henry, David, Streicher, Howard, Little, Richard F., Chiao, Elizabeth, Dittmer, Dirk P., Einstein, Mark H., Cesarman, Ethel, Mitsuyasu, Ronald, Sparano, Joseph A.
• Format: Article
• Language: English
• Subjects: Acquired Immunodeficiency Syndrome - drug therapy; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Cancer; CD4 antigen; CD4 count >100/µL; CD4 Lymphocyte Count; Drug therapy; Effectiveness; HIV; HIV cancer; HIV Infections - complications; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Immune response; Immunotherapy; Malignancy; Monoclonal antibodies; nivolumab; Nivolumab - adverse effects; Safety; Sarcoma; Sarcoma, Kaposi - drug therapy; Solid tumors; Targeted cancer therapy; Therapy; Toxicity; Tumors; Viral Load
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.35110

Background Although immunotherapy has emerged as a therapeutic strategy for many cancers, there are limited studies establishing the safety and efficacy in people living with HIV (PLWH) and cancer. Methods PLWH and solid tumors or Kaposi sarcoma (KS) receiving antiretroviral therapy and a suppressed HIV viral load received nivolumab at 3 mg/kg every 2 weeks, in two dose deescalation cohorts stratified by CD4 count (stratum 1: CD4 count > 200/µL and stratum 2: CD4 count 100–199/µL). An expansion cohort of 24 participants with a CD4 count > 200/µL was then enrolled. Results A total of 36 PLWH received nivolumab, including 15 with KS and 21 with a variety of other solid tumors. None of the first 12 participants had dose‐limiting toxicity in both CD4 strata, and five patients (14%) overall had grade 3 or higher immune related adverse events. Objective partial response occurred in nine PLWH and cancer (25%), including in six of 15 with KS (40%; 95% CI, 16.3–64.7). The median duration of response was 9.0 months overall and 12.5 months in KS. Responses were observed regardless of PDL1 expression. There were no significant changes in CD4 count or HIV viral load. Conclusions Nivolumab has a safety profile in PLWH similar to HIV‐negative subjects with cancer, and also efficacy in KS. Plasma HIV remained suppressed and CD4 counts remained stable during treatment and antiretroviral therapy, indicating no adverse impact on immune function. Trial Registration ClinicalTrials.gov Identifier: NCT02408861. The anti‐PD1 inhibitor nivolumab may be used safely for treatment of cancer, and has activity in Kaposi sarcoma, in people living with HIV receiving antiretroviral therapy, a suppressed HIV viral load, and CD4 lymphocyte count of at least 100/µL.