“HIV Cure and Cancer”: strengthening collaborations to benefit patients des patients
“While HIV and cancer are of course very different diseases, there are also a lot of commonalities,” commented Monsef Benkirane, PhD, CNRS researcher in molecular virology at the Institute of Human Genetics. Indeed, a closer look reveals many similarities. First of all, researchers face the same types of obstacles: the persistence of the virus and of certain types of cancer, and resistance to treatments. In both cases, patients can suffer from “residual disease,” meaning that although the disease itself is undetectable, a few cells can reactivate and cause a relapse. Finally, HIV and cancer often progress invisibly for years before the first symptoms appear, at a stage when the disease is already advanced.
It is therefore logical that treatment strategies for the two conditions are relatively comparable, aiming to both contain and eliminate the disease. In both cases, the immune system and immunology are central considerations, as are epigenetics. “Both for the immune system and for infected or malignant cells, the challenge is understanding the destiny and plasticity of cells that are affected. Recent progress in characterizing the epigenetic parameters that define a cell’s identity, and the ability to reprogram these choices, offers some very exciting avenues for research according to Geneviève Almouzni, PhD, director of the Institut Curie Research Center and CNRS Research Director. “HIV and cancer researchers get together to synergistically explore these possibilities and make advances in therapeutic strategies based on novel combinations.” On the clinical research side, physicians-scientists in both specialties have every reason to work together and draw inspiration from one another, in the opinion of Jean-Philippe Spano, MD, oncologist and specialist in “cancer and HIV” at La Pitié-Salpêtrière in Paris. “For example, in oncology, the time before a medication is made available has gotten considerably shorter in recent years thanks to trials in which phases 1 and 2 are combined, and larger numbers of patients are recruited internationally. Where it once took 10 years, that time has now been cut to 5 years.” This same approach could also benefit research on HIV. Conversely, trials of HIV patients tend to be more interested in the patients’ experience, including how they feel and the effects they attribute to the treatment. Patients are considered full partners in the therapeutic strategy. In oncology research, this is considered a new approach that is just beginning to develop.
Clinical Trials for HIV-positive patients with cancer
Finally, the 2017 event closed with the issue of patients suffering simultaneously from cancer and HIV. In 2010, in the United States alone, 8,000 cases of HIV-positive patients with cancer were recorded; some cases were directly related to HIV (non-Hodgkin's lymphomas and Kaposi’s sarcomas, for example), while others showed no apparent connection. Currently, these patients have very little hope of one day being admitted to a clinical trial. This is a real inequality that must be remedied, believes Thomas Uldrick of the American National Cancer Institute. Often, HIV-positive patients are automatically excluded from trials, even though on average they have a higher risk of developing cancer than the general population, especially as their life expectancy is growing thanks to current treatments. In France, since 2014, the CancerVIH network has been working to catalog clinical trials on cancer that are open to HIV patients. “This international forum at Institut Curie, a symbolic location, brought together the HIV and cancer communities, including all levels of researchers, physicians, pharmaceutical companies, and patients. It was a real success in terms of improving through sharing, an approach very much in the spirit of Marie Curie,” concludes Almouzni.