Dallas Buyers Club.

Headline: Patients with HIV-associated cancer can safely receive PD-1 axis inhibition. In the era of immunotherapy, those with immune-related illness shouldn’t have to get their immune checkpoint inhibitors on the street. But pharma-sponsored trials largely have excluded such patients for fear of any weird unwanted toxicities. This single-arm phase 1 study aims to right those wrongs by including only patients with HIV and an advanced cancer. All patients received pembrolizumab 200 mg q3 weeks, and all had to maintain a CD4 count >100. Among 30 patients enrolled, there were only 6 grade 3+ toxicities. But in the defense of previous trial designers, there was one weird unwanted toxicity in a patient treated for Kaposi sarcoma who developed something deemed “Kaposi sarcoma-associated B-cell lymphoproliferation” resulting in death. TBL:Patients with well-controlled HIV should be allowed on immune checkpoint inhibitor trials. | Uldrick, JAMA Oncol 2019