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ASCO 2012: Breast Cancer Outcomes among HIV Positive Women

Women with HIV can do well on a variety of different types of treatment for breast cancer, but they are prone to infections and blood cell deficiencies and may benefit from adjunct therapies, researchers reported at the American Society of Clinical Oncology Annual Meeting (ASCO 2012) taking place this week in Chicago.

As people with HIV live longer thanks to effective antiretroviral therapy (ART), they have more time to develop malignancies. Breast cancer is generally not one of the non-AIDS cancers that have been found to occur more frequently among HIV positive compared with HIV negative people, but HIV positive women share the high risk of the population at large.

Roberto Enrique Ochoa and colleagues performed a retrospective review of breast cancer cases in HIV positive patients seen at the University of Miami Sylvester Comprehensive Cancer Center/Jackson Memorial Hospital between January 1999 and June 2011.

The review identified 46 women and 1 man with breast cancer and HIV. The average patient age was 46 years (range 31-65 years), 79% were African-American, 21% were white, and 14% were Hispanic. Two-thirds of the women were pre-menopausal.

Results

• 36 patients had HIV before or were diagnosed at the same time with HIV and breast cancer, while 6 were diagnosed with HIV within 1 year after breast cancer diagnosis (5 had unavailable HIV diagnosis dates).
• 23% of patients had CD4 T-cell counts > 500 cells/mm³, 37% had 201-500 cells/mm³, 20% had 51-200 cells/mm³, and 20% had < 50 cells/mm³; 27% had received an AIDS diagnosis.
• 15 people had been diagnosed with breast cancer before the advent of effective combination ART; among those diagnosed after 1996, 60% were on ART.
• Most patients had moderate to advanced breast cancer:

o      Stage 0 -- tumor in situ, or non-invasive cancer: 4%;

o      Stage 1 -- cancer invading normal breast tissue or lymph nodes, with tumors smaller than 2 mm: 6%;

o      Stage 2 -- cancer that has spread to underarm lymph nodes, with tumors smaller than 5 mm: 38%;

o      Stage 3 -- cancer that forms clumps and may have spread further into the chest: 38%;

o      Stage 4 - invasive cancer that has spread to other organs: 9%.

• Half of patients had estrogen receptor (ER) positive breast cancer, 15% had HER-2 positive cancer, and 21% had triple negative cancer.
• 43 patients had localized disease, 32 underwent modified radical mastectomy, 8 had breast-conserving surgery, and 3 refused surgery.
• 26 people received either curative or palliative chemotherapy.
• 11 treated patients reported serious side effects of treatment, including 10 who developed neutropenia with fever or sepsis -- that is, infections related to immune cell deficiency -- including 6 with herpes zoster.
• 1 person experienced acute respiratory distress syndrome (ARDS).
• 3 developed rapidly progressive and fatal AIDS within 6 months of completing chemotherapy.
• Survival rates over the study period were 100% for people with Stage 1 breast cancer, 50% for those with Stage 2, 28% for those with Stage 3, and 0% for those with Stage 4:
• Stage 2 patients were more likely to die of HIV/AIDS than breast cancer, while the reverse was true for Stage 3 and 4 patients.

Based on these findings, the researchers concluded, "Breast cancer in patients with HIV infection spans the spectrum of breast cancer presentations."

"Hormonal therapy, surgery, and radiation therapy were well tolerated," they continued. "Infectious complications were common in patients treated with chemotherapy and routine use of growth factors [for blood cell deficiencies] and prophylactic acyclovir [to prevent herpesvirus infections] should be considered."

6/5/12

Reference

REOchoa, C Kyriakopoulos, J Hurley, et al. Outcomes of 47 patients with human immunodeficiency virus infection treated for breast cancer: A 20-year experience. American Society of Clinical Oncology Annual Meeting (ASCO 2012). Chicago, June 1-5, 2012. Journal of Clinical Oncology 30 (supplement). Abstract 1071.