BETHESDA, Md--The three-member President's Cancer Panel heard
evidence from a number of speakers that HIV-related malignancies
are increasing at a significant rate.
Judith Karp, MD, NCI assistant director for applied science, speaking
for Edward Sondik, acting director of NCI, told the panel that
the putative Kaposi's sarcoma virus, a newly discovered herpesvirus,
may be an "agent provocateur" in both Kaposi's sarcoma
and HIV-related lymphoma.
She said that scientists face major challenges in initiating clinical
investigations of HIV-related malignancies: "There are a
limited number of patients, it is sometimes difficult to recruit
patients into investigative clinical trials, and we face challenges
in clinical agent development. We need to define meaningful endpoints
for novel agents such as angiogenesis inhibitors and cytokines."
Ellen Feigal, MD, senior investigator in the NCI Cancer Therapy
Evaluation Program (CTEP), said that despite logistical, financial,
and other problems, it is important to study HIV-related cancers.
She noted that use of antiretroviral therapy and treatments for
opportunistic infection have improved survival of HIV-infected
patients, and thus cancer incidence will continue to rise.
She cited a need to study the relationship between a well-defined
onset of impaired immunity and cancer pathogenesis, as well as
the relationship between a virus and cancer development. In addition,
she said, recent advances in knowledge about the pathogenesis
of HIV related cancers provide an opportunity to test new therapeutic
Dr. Feigal urged collaboration among NIH, the pharmaceutical industry,
FDA, and independent investigators to develop effective treatments
and interventions as quickly as possible. She encouraged studies
of therapeutic approaches that take into account the treatment
of the underlying HIV disease as well as the cancer.