Real-world outcomes in patients living with HIV with lung cancer and treated with immune checkpoint inhibitors.

Abstract

11156 Background: Lung cancer is one of the most common non-AIDS defining cancers in People Living with HIV (PLWH) and a leading cause of cancer death in PLWH. PLWH were initially excluded from clinical trials of immune checkpoint inhibitors (ICIs) due to concerns for safety and efficacy. Little is known about the real-world rates of immune-related adverse events (irAEs) and survival outcomes in PLWH with lung cancer treated with ICIs. Methods: Adults (age≥18) diagnosed with lung cancer and treated with ICIs between 2015-2021 were identified from the Merative MarketScan database, which contains de-identified healthcare claims of > 250 million patients in the US. We categorized patients into two cohorts based on HIV status: People Living with HIV (PLWH) and those without HIV (PLWoH). We evaluated rates of irAEs and Kaplan-Meier (KM) survival analysis estimated overall survival (OS) in both cohorts; survival function was calculated from first ICI treatment to death or last follow-up. We used the log-rank test to assess statistical differences in survival between the cohorts. Results: 21,259 people with lung cancer and treated with ICIs were identified, and 105 were identified as PLWH. More PLWH treated with ICIs were male (81.9%) and younger (median age 61 yrs) than PLWoH (53.4%, 64 yrs). There was no significant difference in median OS of PLWH (343 days) and PLWoH (364 days, p=0.62). PLWH experienced a similar rate of irAEs (53.3%) as PLWoH (54.6%). Most patients experienced one irAE (55.36% PLWH, 54.33% PLWoH). PLWH experienced irAEs in up to 3 organ systems, and PLWoH in up to 7 organ systems. The most common irAEs in PLWH were neurologic (41.07%), endocrine (39.29%), and renal (32.14%). In PLWoH, endocrine (52.26%), renal (34.93%), and cutaneous (27.82%) were the most common. Patients who experienced irAEs had statistically significantly improved OS in both cohorts compared to those without irAEs (both p<0.0001). Conclusions: We found similar rates of irAEs and OS in a large, real-world population of PLWH with lung cancer treated with ICIs, and people without HIV and lung cancer treated with ICIs. Further research is needed to improve early identification of lung cancer in PLWH and identify predictors of toxicities.