AIDS Malignancy Consortium Opens Major New HIV Lymphoma Trial

The AIDS Malignancy Consortium (AMC) is a group of 15 major medical centers, funded by the National Cancer Institute (NCI), that conduct research in the field HIV-related cancer treatment. The research often focuses on the two most common cancers seen in people with HIV, Kaposi's sarcoma (KS) and lymphoma.

KS is an abnormal growth of blood vessels associated with a herpes-type virus, KS-HV or HHV-8, which most commonly appears as purple nodules on the skin. With current antiretroviral therapy (ART) the incidence of KS has declined dramatically, but still remains a problem for many people. The AMC has several KS trials ongoing.

Lymphoma is a cancer of the lymph nodes. The most common type seen in people with HIV is non-Hodgkin's lymphoma (NHL), but increasingly Hodgkin's lymphoma (HL), which historically has had a higher cure rate with chemotherapy, is also occurring in people with HIV infection. With current ART, the overall incidence of lymphoma is declining, but not as much as the declines seen in KS. Fortunately, one of the most aggressive lymphomas, that of the brain, or CNS lymphoma, has had a more dramatic decline with ART. In fact, the AMC has been unable to enroll enough people in their current CNS lymphoma trial due to the declining incidence of this type of lymphoma. There has also been a decline, though not as significant, in some of the other more aggressive lymphomas, such as the immunoblastic type, with ART. However, there still remains an ongoing need for clinical research into the treatment of HIV-associated lymphomas.

The AMC has just completed a large NHL trial, enrolling over 150 people. This trial, number 010, is being analyzed and results will be available next spring. The 010 trial compared the standard chemotherapy regimen, CHOP, with CHOP plus rituximab, a monoclonal antibody that attacks lymphoma cells. Rituximab attacks a site on the surface of lymphocytes known as CD20. Most HIV-associated lymphomas have CD20 present on the lymphoma cell surfaces. Rituximab plus CHOP has already been shown to be better than CHOP alone in people with lymphoma who are HIV-negative.

The next AMC lymphoma trial just starting is trial 034. This trial will study a chemotherapy regimen that is probably more potent than CHOP, but needs to be given as a four-day continuous infusion every 3 weeks, for 2 to 6 cycles, depending on response. The regimen is known as EPOCH. The study will determine if treatment results are better if rituximab is given with the EPOCH or afterwards. A total of 70 people will be enrolled in this trial. A trial conducted by the NCI using a similar infusional regimen, CDE, showed very high response rates, with few relapses in HIV-associated NHL. In that NCI study, all anti-HIV drugs treatment was stopped during the chemotherapy treatment period because of concerns over possible drug interactions. However, the AMC 034 trial will allow trial participants and their health care providers to decide whether or not to continue ART during the chemotherapy treatment period.

There is a local AMC Unit at Virginia Mason Medical Center, headed by Dr. David Aboulafia, and a subunit at Harborview's Madison Clinic. For information about this, or other AMC trials, you can call Cheryl Weaver, Study Coordinator, at 206-223-6835. Also, information about ongoing AMC trials is available at their Web site: www.amc.uab.edu/.