ON THIS PAGE: You will learn about the different types of treatments doctors use for people with the most common types of HIV/AIDS-related cancers. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for HIV/AIDS-related cancers. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How HIV/AIDS-related cancer is treated

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatment. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

The common types of treatments used for HIV/AIDS-related cancers are described below by general treatment and then listed by type of cancer. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for HIV/AIDS-related cancer because there are different treatment options.

It is often difficult to treat cancer in people with AIDS because of the increased risk of infections from lower levels of white blood cells and lowered immune function caused by HIV. However, doctors and researchers are always looking for better treatments, and recent research has resulted in medical advances.

Learn more about making treatment decisions.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan being recommended. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Antiretroviral treatment (ART)

It is extremely important that everyone with HIV/AIDS and an associated cancer receive highly active antiretroviral treatment (ART) both during the cancer treatments and afterward. ART can effectively control HIV in most patients. Better control of the HIV decreases the side effects of many of the cancer treatments, may decrease the chance of a cancer recurrence, and can improve a person's chance of recovery from the cancer.

General types of treatment for an HIV/AIDS-related cancer

In addition to ART and caring for symptoms and side effects, the following treatments may be used.

Therapies using medication

Treatments using medication are used to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This type of medication is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team about how to safely store and handle it.

The types of medications used for HIV/AIDS-related cancer include:

• Chemotherapy

• Immunotherapy

• Targeted therapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all cancers have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors involved in your cancer. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. External-beam radiation therapy may be given as a palliative treatment. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.

Surgery

Surgery is the removal of the tumor or lesion and some surrounding healthy tissue, called a margin, during an operation. Surgery may be performed by a surgical oncologist, a doctor who specializes in treating cancer using surgery. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

Treatment of Kaposi sarcoma

For patients with epidemic Kaposi sarcoma, antiretroviral treatment (ART, see above) for HIV/AIDS is usually used before any other treatment options to treat the tumor and reduce the patient’s symptoms. ART may be given alone or in combination with therapies using cancer medication, depending on the spread of the disease and the patient’s symptoms.

Rarely, ART can make preexisting infections and the Kaposi sarcoma worse. This reaction is called immune reconstitution inflammatory syndrome (IRIS). If symptoms get worse in the first few weeks after starting ART, talk with your doctor.

Specific treatments can include the following:

• Surgery. Surgery is most useful when the lesions are located in a single area or a few specific areas. There are 2 types of surgical procedures used for Kaposi sarcoma:

• Curettage and electrodesiccation. During this procedure, the cancer is removed with a sharp, spoon-shaped instrument called a curette. The area can then be treated with electrodesiccation, which uses an electric current to control bleeding and destroy any remaining cancer cells. This procedure may leave a flat, pale scar.

• Cryosurgery. Cryosurgery uses liquid nitrogen to freeze and destroy cells. The skin will later blister and fall away. This procedure will sometimes leave a pale scar. More than 1 freezing may be needed. This procedure is also called cryotherapy or cryoablation.

• Photodynamic therapy. During photodynamic therapy, a light-sensitive substance is injected into the lesion. This substance stays longer in the cancer cells than in the healthy cells. A laser is then directed at the lesion to destroy the cancer cells that have absorbed the light-sensitive substance.

• Radiation therapy. Radiation therapy may an option for Kaposi sarcoma.

• Chemotherapy. Sometimes, chemotherapy is injected directly into the lesion to destroy the cancer cells, called an intralesional injection. Chemotherapy may help control advanced disease, although curing HIV/AIDS-related Kaposi sarcoma with chemotherapy is extremely rare. Usually, for HIV/AIDS-related Kaposi sarcoma, chemotherapy is used to help relieve symptoms and to lengthen a patient’s life. Common drugs for Kaposi sarcoma include vinblastine (Velban), liposomal doxorubicin (Doxil), paclitaxel (available as a generic drug), and vinorelbine (Navelbine).

• Topical medications. Skin creams to shrink or stop the growth of lesions may be recommended. Topical creams often do not stop all the cancer, but they can improve a person's appearance. Imiquimod (Aldara) cream is used to treat many skin conditions, including basal cell carcinoma and Kaposi sarcoma. Alitretinoin (Panretin) is a gel medication that is related to vitamin A that can make lesions from Kaposi sarcoma go away. The gel is put on the lesions for many weeks.

• Targeted therapy. Targeted therapy for Kaposi sarcoma includes kinase inhibitors and immune-modulating drugs, such as lenalidomide (Revlimid), pomalidomide (Pomalyst), and thalidomide (Thalomid).

• Immunotherapy. Some people with HIV/AIDS-related Kaposi sarcoma may receive alpha-interferon (Roferon-A, Intron A, Alferon), which appears to work by changing proteins on the surface of the cancer cells and by slowing their growth. The most common side effects of alpha-interferon are low levels of white blood cells and flu-like symptoms.

Learn more about the types of treatments for Kaposi sarcoma.

Treatment of non-Hodgkin lymphoma

The main treatments for HIV/AIDS-related NHL are chemotherapy, targeted therapy, and radiation therapy.

• Chemotherapy. Chemotherapy is the most common treatment for NHL. Previously, chemotherapy for HIV/AIDS-related NHL was given at lower doses because of the person’s weakened immune system. Now, with better ART, people with HIV/AIDS-related NHL can usually receive the same doses of drugs given to people with lymphoma who do not have HIV.

• Immunotherapy. For B-cell NHL, rituximab (Rituxan) may be used. Rituximab is a type of therapy called a monoclonal antibody. A monoclonal antibody recognizes and attaches to a specific protein on the lymphoma cells, and it does not affect cells that do not have that protein. Rituximab targets a molecule called CD20 that is located on the surface of B cells. It is used together with chemotherapy for most patients. It can also be used in combination with lenalidomide, an immune-modulating drug. Three other anti-CD20 monoclonal antibodies may also be used, obinutuzumab (Gazyva), ofatumumab (Arzerra), and rituximab-abbs (Truxima).

  A newer type of immunotherapy, called chimeric antigen receptor (CAR) T-cell therapy, can be effective in treating B-cell lymphoma that has come back after treatment or that has not responded to chemotherapy. However, there is little known about how CAR T-cell therapy works in treating HIV/AIDS-related lymphoma.

• Targeted therapy. There are now many targeted therapy agents that target B-cell lymphomas and leukemias, including inhibitors of BCL2, Bruton's tyrosine kinase (BTK), PI3 kinase, and other components of the B-cell receptor pathway. The decision to use one or more of these in combination with another targeted therapy, chemotherapy, or immunotherapy, depends on the specific subtype of lymphoma being treated. Targeted therapy also may be considered for lymphoma that has come back or if standard chemotherapy is not possible. Talk with your doctor about the possible side effects for a specific medication and how they can be managed. It is also important to make sure that a targeted therapy will not interact with treatments for HIV or other medications because this could lead to less effective treatment or potential side effects.

• Radiation therapy. For people with HIV/AIDS-related lymphoma, radiation therapy may be given alone or in combination with chemotherapy.

Learn more about treatment options for NHL.

Treatment of cervical cancer

Treatments for the precancerous condition called CIN (see Introduction) are generally not as effective for people with HIV/AIDS because of a weakened immune system. Often, the standard treatment for HIV/AIDS can lower the symptoms of CIN.

Patients with invasive cervical cancer and HIV/AIDS that is well controlled with medication generally receive the same treatments as those who do not have HIV/AIDS. Common treatment options include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Learn more about cervical cancer treatment options.

Metastatic HIV/AIDS-related cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of the treatments discussed above. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and difficult to bear. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat the specific type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.