Abstract
BACKGROUND: Lung cancer is the most common non-acquired immunodeficiency syndrome-defining cancer in people living with human immunodeficiency virus (PLWH). PLWH were initially excluded from clinical trials of immune checkpoint inhibitors (ICIs) because of safety and efficacy concerns; little is known about real-world rates of immune-related adverse events (irAEs) and outcomes in PLWH with lung cancer treated with ICIs. METHODS: Adults (age ≥18 y) diagnosed with lung cancer and treated with ICIs between 2015 and 2021 were identified from the Merative MarketScan database. Patients were stratified into the following two cohorts: PLWH and PLWoH (people living without human immunodeficiency virus). We evaluated rates of irAEs and estimated overall survival (OS) between groups with Kaplan-Meier survival analysis; survival function was calculated from ICI initiation to death or last follow-up. We used the log-rank test to assess statistical differences in survival between cohorts. RESULTS: Of the 21,259 people with lung cancer treated with ICIs, 105 were identified as PLWH. There was no significant difference in median OS of PLWH versus PLWoH (343 versus 364 days, p = 0.62). PLWH experienced a similar rate of irAEs (59.1%) as PLWoH (58.8%). The most common irAEs in PLWH were neurologic (35.48%), endocrine (33.87%), renal (24.19%), and cardiac (24.19%), versus endocrine (47.69%), renal (28.80%), cutaneous (25.22%), and cardiac (24.39%) in PLWoH. Patients who experienced irAEs had significantly improved OS in both cohorts versus those without irAEs (both p < 0.0001). CONCLUSIONS: We found similar rates of irAEs and OS in real-world populations of PLWH and PLWoH with lung cancer treated with ICIs. Further research is needed to identify predictors of toxicities.