Chemotherapy in the HAART

In the HAART era, more recent standard chemotherapy regimens have been reported without excessive toxicity due to restored immunity.90 The AIDS Malignancy Consortium (AMC) reported using, in 65 patients, reduced doses of cyclophosphamide and doxorubicin, combined with vincristine and prednisone (modified CHOP, mCHOP) and full doses of CHOP combined with G-CSF with concomitant HAART. Complete response rates were 30% and 48% in the reduced-and full-dose groups, respectively.94 No long-term outcomes were reported in this study. Other studies of CHOP-based chemotherapy and concurrent HAART have resulted in median survival of 2 years.53,95

Risk-adaptive chemotherapy has also been studied comparing the post- to pre-HAART era. 485 HIV-infected individuals were assigned randomly to chemotherapy after risk stratification based on an HIV score (comprising performance status, prior AIDS, and CD4-positive cell counts < 100/mm3).Two hundred eighteen good risk patients (HIV score 0) received doxorubicin, cyclophosphamide, vinde-sine, bleomycin, and prednisone (ACVBP) or CHOP, 177 intermediate risk patients (HIV score 1), CHOP or low-dose CHP, and 90 poor risk patients (HIV score 2 or 3), low-dose CHOP or vincristine and steroid. Five-year overall survival in the good risk group was 51% for ACVBP versus 47% for CHOP (p = 0.85), in the intermediate risk group, 28% for CHOP versus 24% for low-dose CHOP (p = 0.19), and in the poor risk group 11% for low-dose CHOP versus 3% for vincristine and steroid (p = 0.14). Only significant factors in this study for overall survival proved to be HAART (relative risk (RR) 1.6, p = 0.0002),HIV score (RR 1.7, p = 0.0001), and the IPI score (RR 1.5,p = 0.0012), but not the intensity of chemotherapy.96 An infusional regimen of cyclophosphamide, doxorubicin, and etoposide (CDE) with and without HAART (only didanosine) resulted in complete response rate of 45% and median overall survival was 12.8 months. At the time of the analysis, 30% in the pre-HAART group were alive compared with 47% in the HAART group. Further, patients in the HAART group experienced less nonhematologic toxicity (22% vs 42%), thrombocytopenia (31% vs 52%), and anemia (9% vs 27%).97

0 0

Post a comment