NCCN guidelines for patients with HIV seek to reduce cancer care gaps

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The National Comprehensive Cancer Network has released a new NCCN Clinical Practice Guidelines in Oncology intended to help make sure people living with HIV who are diagnosed with cancer receive safe, necessary treatment.

In 2010, an estimated 7,760 PLWH in the United States were diagnosed with cancer, representing an approximately 50% higher rate than the general population. However, studies have found PLWH are treated for cancer at significantly lower rates than HIV-negative people with cancer, despite most treatment courses being safe and effective in this population.

The most-common types of cancer occurring in people living with HIV are, in order of incidence: non-Hodgkin’s lymphoma, Kaposi sarcoma, lung cancer, anal cancer, prostate cancer, liver cancer, colorectal cancer, Hodgkin lymphoma, oral/pharyngeal cancer, female breast cancer, and cervical cancer.

The new NCCN Guidelines for Cancer in People Living With HIV includes general advice—while highlighting the importance of working in collaboration with an HIV specialist—as well as specific treatment recommendations for non-small cell lung cancer, anal cancer, Hodgkin lymphoma, and cervical cancer.

Additional recommendations can be found in the recently-released NCCN Guidelines for AIDS-Related Kaposi Sarcoma as well as the AIDS-related B-cell lymphomas section of the NCCN Guidelines for B-cell Lymphomas.

Among the recommendations found in the new NCCN Guidelines:

  • Most PLWH who develop cancer should be offered the same cancer therapies as HIV-negative individuals, and modifications to cancer treatment should not be made solely on the basis of HIV status.

  • Care for patients diagnosed with HIV should be co-managed with an oncologist and an HIV specialist.

  • Oncologists and HIV clinicians, along with HIV and oncology pharmacists, if available, should review proposed cancer therapy and ART for possible drug-drug interactions and overlapping toxicity concerns prior to initiation of therapy.

The NCCN Guidelines Panel for Cancer in People Living With HIV included oncologists, radiologists, infectious disease specialists, surgical oncologists, pharmacists, and a patient advocate. The panel stressed the importance of increasing the number of PLWH who participate in clinical trials for cancer treatments. Clinicians working with PLWH who have cancer should use clinicaltrials.gov to help patients find appropriate trials.

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