ESTRO 2022

Session Item

Saturday

May 07

14:15 - 15:15

Mini-Oral Theatre 2

06: GI

Co-Chair: Daniel Portik, The Netherlands;

Chair: James Good, United Kingdom

Session Type: Mini-Oral

Track: Clinical

Journey:

Clinical outcomes of HIV-positive patients with anal cancer in the ANABASE multicentric cohort

Cécile Evin, France

Presentation Number: MO-0226

Abstract

Abstract Title:

Clinical outcomes of HIV-positive patients with anal cancer in the ANABASE multicentric cohort

Authors:

Cecile Evin¹, Laurent Quéro², Karine Le Malicot³, Sarah Blanchet-Deverly², Eric François⁴, Chloé Buchalet⁵, Claire Lemanski⁵, Nabil Baba Hamed⁶, Eleonor Rivin del Campo¹, Laurence Bauwens⁷, Pascal Pommier⁷, Astrid Lièvre⁸, David Tougeron⁹, Vincent Macé¹⁰, Guillaume Sergent¹¹, Olivia Diaz¹², David Zucman¹³, Françoise Mornex¹⁴, Christophe Locher¹⁵, Anne De la Rochefordière¹⁶, Véronique Vendrely¹⁷, Florence Huguet¹

¹Hôpital Tenon, APHP, Radiation Oncology, Paris, France; ²Hôpital Saint-Louis, APHP, Radiation Oncology, Paris, France; ³Fédération francophone de cancérologie digestive (FFCD), Biostatistics department, Dijon, France; ⁴Centre Antoine Lacassagne, Medical Oncology, Nice, France; ⁵Institut du Cancer de Montpellier, Radiation Oncology, Montpellier, France; ⁶Groupe Hospitalier Paris Saint Joseph, Medical Oncology, Paris, France; ⁷Centre Léon Bérard, Radiation Oncology, Lyon, France; ⁸CHU de Rennes, Gastroenterology, Rennes, France; ⁹CHU de Poitiers, Gastroenterology, Poitiers, France; ¹⁰CHD-Vendée, Gastroenterology, La Roche sur Yon, France; ¹¹Institut de Cancérologie Paris Nord, Radiation Oncology, Paris, France; ¹²Groupe Hospitalier Mutualiste de Grenoble, Radiation Oncology, Grenoble, France; ¹³Hôpital Foch, Hospital-Office Network Val de Seine, Paris, France; ¹⁴Hôpital Lyon Sud, Radiation Oncology, Lyon, France; ¹⁵Centre Hospitalier de Meaux, Hepato-gastroenterology, Meaux, France; ¹⁶Institut Curie, Radiation Oncology, Paris, France; ¹⁷CHU Bordeaux, Radiation Oncology, Bordeaux, France

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Purpose or Objective

Squamous cell carcinoma of anal canal (SCCAC) is a rare cancer, but frequently associated with HIV infection. We aim to compare clinical outcomes and tolerance according to HIV status in patients with SCCAC treated with modern (chemo)radiotherapy.

Material and Methods

This is a subgroup analysis of the SCCAC ANABASE multicentric cohort conducted by the Fédération Francophone de Cancérologie Digestive in 60 French centers. Data were collected both prospectively and retrospectively. HIV-positive patients were compared to HIV-negative patients. Clinical outcomes including overall survival (OS), response rate (RR), locoregional recurrence-free survival (LRFS), relapse-free survival (RFS), colostomy-free survival (CFS), cancer specific survival (CSS), severe acute and late toxicity (grade ≥ 3) were evaluated. Prognostic factors were explored using Cox regression model.

Results

Between January 2015 and April 2020, 1097 patients with localized SCCAC (stage I, II, III) and treated with (chemo)radiation were included. Only the 488 patients with known HIV status were included in our analysis (86 HIV-positive patients and 402 HIV-negative patients). Median follow-up was 35.8 months.

HIV-positive patients were younger (median age of 57 vs 64 years in HIV-positive and HIV-negative patients, respectively, p<0.01) and predominantly male (77% vs 23%, p<0.01). Initial tumor characteristics were similar in both groups (T stage, p=0.32 and N stage, p=0.54). Most of patients received Intensity-Modulated Radiation Therapy (IMRT, 80.7%) and concurrent chemotherapy (80.9%).

		OS	CSS	RFS	LRFS	CFS
HIV-positive	At 3 years [CI 95%]	71.6% [59.0 ; 81.0]	83.6% [71.4 ; 90.9]	61.5% [48.9 ; 71.9]	65.3% [53.1 ; 75.0]	60.4% [47.8 ; 70.9]
HIV-negative	At 3 years [CI 95%]	85.1% [80.2 ; 88.8]	90.8% [86.7 ; 93.7]	74.7% [69.4 ; 79.3]	78.6% [73.5 ; 82.8]	76.2% [70.9 ; 80.7]
	Hazard-Ratio [CI 95%]	2.1 [1.2 ; 3.5]	1.7 [0.8 ; 3.5]	1.5 [0.98 ; 2.3]	1.7 \|1.1 ; 2.7]	1.7 [1.1 ; 2.6]
	p-value	0.007	0.14	0.06	0.02	0.01

OS, LRFS and CFS were significantly lower in HIV-positive patients (Table 1). HIV-positive patients relapsed mostly locally or locoregionally (91.7% of HIV-positive patients with a recurrence), whereas recurrences in HIV-negative patients were mainly metastatic (52.7% of HIV-negative patients with a recurrence, p=0.002).

Treatment compliance was similar and no more break or severe toxicities were reported among HIV-positive patients (47.7% grade ≥ 3 acute toxicities in HIV-positive patients vs 45.5% in HIV-negative patients, p=0.65).

Only WHO performance status ≥ 1 was associated with decreased OS in multivariate analysis. WHO status was also associated, as well as T3-4 stages (compared with T1-2 stages), with lower RFS, LRFS and CFS.

Conclusion

HIV-positive patients treated by (chemo)radiation for localized SCCAC had a poorer overall survival than HIV-negative patients, as well as poorer locoregional recurrence-free and colostomy free survivals. Treatment toxicity was not increased in HIV-positive patients with modern IMRT techniques.