Preliminary data from HIV-seropositive patients at Johns Hopkins demonstrate a high rate of death from lung cancer. We derived 87 cases of HIV-seropositive patients with lung cancer who had been treated at the institution. Almost all patients were young (median age 46 years), African-American males from inner city Baltimore with a strong history of cigarette smoking. The prevalence of smoking was 97%, with 89% being current smokers. Despite patients being carefully followed for their HIV disease, only 4.6% of the HIV-positive lung cancer patients initially presented with stage 1 disease, and only 11 patients (13%) were able to undergo surgery. Over the past 5 years, six large-scale computed tomography (CT) lung cancer screening trials of 18,387 patients at high risk for lung cancer have been published. Of 140 lung cancers detected, 79% (110/140) had stage 1 disease. This contrasts with 24% of patients presenting with stage 1 lung cancer patients without CT screening. This suggests that CT screening is sensitive in detecting small, early stage lung cancer. We hypothesize that CT screening of heavy HIV-seropositive smokers will detect a higher proportion of stage 1 lung cancers than are currently being detected. This project is a prospective cohort study that will enroll 200 HIV-seropositive smokers who have current or previous smoking history of at least 20 pack years. We anticipate 18 lung cancers in the first year alone.
Specific aim 1 addresses if differences in stage distribution of HIV-positive patients at lung cancer diagnosis can be determined between those HIV-positive heavy smokers who are screened by spiral CT and historical controls. Our second specific aim focuses on the establishment of a specimen bank of serum, sputum, and tissue from these screened HIV-positive smokers. Our third specific aim is to use epigenetic analysis of sera and sputa collected in Specific Aim 2 as a complementary approach to low dose helical CT in order to discriminate radiologically indeterminate nodules as either molecularly positive or negative. ? ?

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23CA117820-02
Application #
7115021
Study Section
Subcommittee G - Education (NCI)
Program Officer
Gorelic, Lester S
Project Start
2005-09-01
Project End
2008-08-31
Budget Start
2006-09-01
Budget End
2007-08-31
Support Year
2
Fiscal Year
2006
Total Cost
$140,130
Indirect Cost
Name
Johns Hopkins University
Department
Surgery
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Hulbert, Alicia; Hooker, Craig M; Keruly, Jeanne C et al. (2014) Prospective CT screening for lung cancer in a high-risk population: HIV-positive smokers. J Thorac Oncol 9:752-9
Hooker, Craig M; Meguid, Robert A; Hulbert, Alicia et al. (2012) Human immunodeficiency virus infection as a prognostic factor in surgical patients with non-small cell lung cancer. Ann Thorac Surg 93:405-12
Meguid, Robert A; Hooker, Craig M; Taylor, Joshua T et al. (2009) Recurrence after neoadjuvant chemoradiation and surgery for esophageal cancer: does the pattern of recurrence differ for patients with complete response and those with partial or no response? J Thorac Cardiovasc Surg 138:1309-17
Brock, Malcolm V; Hooker, Craig M; Engels, Eric A et al. (2006) Delayed diagnosis and elevated mortality in an urban population with HIV and lung cancer: implications for patient care. J Acquir Immune Defic Syndr 43:47-55