Characteristics, treatment patterns, and outcomes of HIV-associated lung cancer.

Abstract

8050 Background: Lung cancer is a leading cause of cancer-related mortality in people with HIV (PWH). Prior studies have shown worse survival in PWH with lung cancer compared to people without HIV (PWoH) with lung cancer. However, it is unclear whether this difference in survival is due to differences in tumor biology, socioeconomic factors, and/or treatment disparities. Methods: This is a retrospective study of PWH and lung cancer identified from 2005 - 2024 within MedStar Health serving a major urban area with a high burden of HIV. Age and race matched PWoH and lung cancer were used as a control group. Clinical, pathological, and molecular characteristics, along with social determinants of health, treatment patterns, and outcomes were collected. Factors associated with survival and receipt of stage-appropriate treatment were determined using multivariable analysis. Results: We analyzed 148 PWH with lung cancer and 127 PWoH with lung cancer. The median age at lung cancer diagnosis among PWH was 61.8 years, with a statistically significant trend of increasing age over the study period. PWH were disproportionately male (65%), unmarried (62%), had government provided health insurance (79%), and had more comorbidities compared to the control group. The stage at diagnosis was similar between both groups, with 68% of PWH and 66% of PWoH diagnosed at stage III and IV, and no evidence of stage migration to earlier stage observed over the study period. Similar rates of KRAS/EGFR/ALK/BRAF alterations were observed. Stage-appropriate treatment was received by 70% of PWH and 82% of PWoH (p=0.057). Median OS (mOS) in stages I and II was 5.8 years in PWH and 8.8 years in PWoH (p=0.22). Across all stages, mOS was 1.5 years in PWH and 1.9 years in PWoH (p=0.23); the difference in mOS was attenuated when comparing patients who received stage-appropriate treatment (p=0.52). Among PWH with lung cancer, factors associated with improved survival included receipt of chemotherapy (HR 0.35, p<0.001) and immunotherapy (HR 0.53, p=0.042), and higher CD4 count (>400 cells/mm3) at diagnosis (p=0.013). Factors that contributed to whether PWH received stage appropriate treatment were based on performance status, with an ECOG ≥3 significantly associated with lower likelihood of receiving treatment (OR 0.01, p=0.003). Among PWH, 96 were eligible for lung cancer screening per the USPSTF criteria, but only 7 patients (7.3%) were diagnosed through a screening CT scan. Conclusions: Decreased CD4 count, poor performance status at presentation, and advanced disease stage at diagnosis may contribute to worse outcomes in PWH with lung cancer. The lower rate of diagnosis through lung cancer screening and the potential number of eligible patients at the time of lung cancer diagnosis highlight missed opportunities for early detection in PWH. Targeted interventions to address barriers to timely diagnosis and stage-appropriate treatment could improve survival outcomes in PWH.