The following is a summary of “Comparison of Stage I Non–Small-Cell Lung Cancer Treatments for Patients Living With HIV: A Simulation Study,” published in the November 2023  issue of Pulmonology by Sigel, et al.

People living with HIV are most likely to die from non-small-cell lung cancer (NSCLC). Still, there are no results from clinical trials that show how to treat early-stage lung cancer in PWH. The Researchers used data from big HIV and cancer groups to set up a simulation model that lets them compare treatments for stage I NSCLC based on the features of each patient. To set up the parameters of the model, they looked at quality of life and outcome data for PWH and NSCLC patients from a number of big cohort studies. 

They used evidence synthesis methods to figure out how good 4 stage I NSCLC treatments are compared to each other: lobectomy, segmentectomy, wedge resection, and stereotactic body radiotherapy. Then, they made studies comparing treatments based on quality-adjusted life year (QALY) gains for each patient based on age, tumor size and histopathology, HIV disease features, and major illnesses.

The QALY gains were highest for lobectomy and segmentectomy, regardless of the age, tumor size, or disease group. The best way to treat a patient depends on their gender, age, and HIV status. For women aged 80 to 84 with tumors 0 to 2 cm in size, wedge removal was one of the best options. Stereotactic body radiation was part of some of the best plans for people aged 80 to 84 who had more than one illness, and it was also a good choice for many older patients or those who weren’t good at controlling their HIV. In model studies of different treatments for stage I NSCLC in PWH, extensive surgery removal was often linked to the highest expected QALY gains. However, less active methods were considered non-inferior in some older patient groups with other health problems.

Source: sciencedirect.com/science/article/abs/pii/S1525730423001225