G. L. Fuligni1, K. M. Banson2, C. Oh3, J. D. Domogauer4, K. L. Du5, C. Hill6, A. Mahadevan7, J. Xiao8, and F. Shaikh2; 1NYU Grossman School of Medicine, New York, NY, 2NYU Radiation Oncology, New York, NY, 3Biostatistics, Department of Population Health, NYU Langone Health, New York, NY, 4NYU Langone Health, New York, NY, 5Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, 6Department of Radiation Oncology, New York University Grossman School of Medicine, New York, NY, 7NYU Langone Health Laura and Isaac Perlmutter Cancer Center, New York, NY, 8New York University Grossman School of Medicine, Department of Radiation Oncology, New York, NY
Purpose/Objective(s): Patients with HIV are more likely to develop anal cancer. With the advent of highly active antiretroviral therapy and associated improvement in survival, incidence of anal cancer in HIV positive (HIV+) patients has increased. Prior retrospective data suggest that HIV+ patients experience poorer outcomes compared to the general population. This modern series reports the outcomes of HIV+ patients with cancer and treated with chemoradiation (CRT). Materials/
Methods: Retrospective data were collected for HIV+ patients with stage I-IIIC anal squamous cell carcinoma (ASCC) who received CRT at a single institution from 2012-2023. Baseline patient, tumor, and treatment characteristics were obtained. Colostomy free survival (CFS), local recurrence free survival (LRFS), progression free survival (PFS), and overall survival (OS) were evaluated using the Kaplan-Meier method. Results: 58 HIV+ patients with ASCC were included. Median age at diagnosis was 55 years old (IQR 46, 63), and majority of patients were male (81%) and white (41%) followed by black (33%). Median pretreatment CD4 cell count was 278 cells/mm3 (IQR 65, 505) and the majority of patients had an undetectable viral load. For those who had a detectable viral load, median was 285 copies copies/mL (IQR 72, 2113.2). Distribution by prognostic stage is shown in the table. The median time from diagnosis to start of treatment was 63 days (IQR 37, 80). 46 (79%) patients presented with symptoms, and 8 (14%) patients were detected by screening. Most received IMRT with a median dose to tumor of 54 Gray (IQR 50.4, 54) over a median of 42 days (IQR 39, 46). There were 11 (19%) patients that stopped radiation treatment prematurely, 6 (10%) that underwent dose-reduced chemotherapy, and 5 (8.6%) patients that stopped chemotherapy prematurely. The median follow up was 20.1 months (IQR 7.2, 65.3). Two-year CFS was 86% (95% CI, 76%, 97%), LRFS 77% (95% CI , 65%, 91%), PFS 75% (95% CI, 63%, 89%), and OS 87% (95% CI, 76%, 98%). Age, sex, T stage and CD4 count were not significantly associated with endpoints on univariate analysis. In terms of acute toxicities grade 2 or greater, 17 (33.8%) patients experienced fatigue, 15 (26%) patients experienced diarrhea, and 42 (74%) patients experienced dermatitis. 30 (53%) patients had persistent cytopenia at 3 months post treatment and 20 (35%) patients had persistent cytopenia at 6 months. 10 (17%) patients were hospitalized during treatment and 10 (17%) ultimately underwent colostomy. Conclusion: In this modern series, HIV+ patients with anal cancer had low rates of anal cancer screening with increased rates of premature treatment stops, hospitalizations, and toxicity compared to historical controls. Further research is necessary to evaluate causes of disparities in outcomes and quality of life.
