Kaposi’s sarcoma

December 2006     View PDF     En español
Reprinted from dermnetnz.org, New Zealand;
author, Jane Morgan MD CHB MRCP FACSHP

Treatment

If the lesions are not widespread or troublesome, often the best approach is simply to treat the underlying HIV infection with potent antiretroviral drug combinations that suppress HIV replication. These drugs reduce the frequency of Kaposi sarcoma and may also prevent its progression or the development of new lesions. It is not yet clear why this approach works; one opinion is that the improvement in immune function results in reduced levels of tumour growth-promoting proteins.

The choice of more specific treatment depends largely on the extent of the disease:

Treating localised lesions
Small, localised lesions are generally only treated if they are painful or they are causing cosmetic problems. It should be noted that lesions tend to recur after local treatments. Treatments include:

• Freezing with liquid nitrogen (cryotherapy)
• Treatment with radiation
• Surgical removal
• Injection with anti-cancer drugs such as vinblastine
• Topical application of alitretinoin gel (Panretin). This drug is not yet available in New Zealand.

Treating extensive or internal lesions with systemic therapy
A combination of anti-cancer drugs are given but at lower than usual dosages because of the pre-existing HIV-related immunosuppression.

Other chemotherapy treatments that are used in some international centres include paclitaxel and liposomal forms of the standard anti-cancer drugs, doxorubicin or daunorubicin. &squo;Liposomal’ means that the drugs are coated in small fat bubbles, or liposomes which allows better absorption, hopefully resulting in fewer side effects.

Interferon-alpha inhibits some of the growth factors associated with Kaposi sarcoma but response tends to be better in those with CD4 cell counts greater than 200 /mm3.

Clinical trials into a wide range of other therapies are ongoing. Some examples of these are:

• Photodynamic therapy (a combination of a photosensitiser and light energy)
• Isotretinoin (a vitamin-A derivative)
• Cytokine inhibitors
• The pregnancy hormone, human chorionic gonadotropin (HCG); Kaposi sarcoma lesions disappear in some women when they become pregnant.
• Ganciclovir and foscarnet (antiviral medications) have been recently reported to result in lower rates of Kaposi sarcoma amongst those being treated for CMV retinitis (inflammation of the retina caused by cytomegalovirus) and are currently being studied. Aciclovir, another antiviral, has been tried, but does not appear to work.

Prognosis

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