Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
KAPOSI'S SARCOMA
Current Therapy in Hematology-Oncology-3. Brain MC, Carbone PP, eds. Current Therapy Series, Toronto, B.C. Decker, p. 353-5, 1988.. Unique Identifier : AIDSLINE ICDB/89657396 Richman SP; Vogel CL; Div. of Medical Oncology, Papanicolaou Comprehensive Cancer; Inst., Miami, FL
Abstract:
Kaposi's sarcoma (KS) occurs in four clinical settings. Therapy for AIDS-associated KS (AIDS-KS), including chemotherapy, interferons (IFNs), and radiotherapy (RT), and management of classic KS, African KS, and KS in renal transplant recipients are discussed. For AIDS-KS, a staging system has been proposed that is roughly analogous to that used in lymphomas: Stage I, cutaneous, locally indolent disease; Stage II, cutaneous, locally aggressive disease with or without regional lymphadenopathy; Stage III, generalized mucocutaneous and/or lymph node involvement; and Stage IV, visceral disease. Patients are further subdivided into subtype A consisting of the absence of systemic signs or symptoms and subtype B consisting of systemic signs involving weight loss greater than 10% and fever exceeding 100 F orally, unrelated to an identifiable infection and persisting more than 2 wk. In practice, Stage I has relatively good prognosis, but is relatively rare in epidemic KS. Stage II is encountered even less frequently. Stages IIIA and IVA also have relatively good prognosis, with 85% survival at 18 mo, but Stages IIIB and IVB have poor prognosis. Chemotherapeutic agents that are active in AIDS-KS include vinblastine, etoposide, vincristine, and bleomycin. Lymphoblastoid IFN and recombinant alpha-2b IFN are both active in AIDS-KS; beta-IFN has not been tested extensively and gamma-IFN appears to be inactive. AIDS-KS is radiosensitive. RT may be used for the relief of painful, inconvenient, or incapacitating lesions in localized areas, such as large nodules on the extremities or oral lesions interfering with dentition. Classic KS is a chronic, multifocal malignancy to be treated primarily with palliative intent. Single or localized lesions may be surgically excised, but multiple or recurrent disease may be successfully palliated with RT. The most frequently used palliative agent has been vinblastine alone, with response rates as high as 90%. Regionally localized African KS is sensitive to RT and to such drugs as nitrogen mustard, actinomycin D, and combinations of these agents with dacarbazine. The actinomycin D regimens have yielded response rates of 90%; combination chemotherapy appears to be more active than single agent therapy. Therapy for KS in renal transplant patients has been individualized. Responses have been seen with reduction in immunosuppressive therapy alone. Localized lesions have been treated with surgery and RT.
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS Antineoplastic Agents/THERAPEUTIC USE Combined Modality Therapy Human Interferons/THERAPEUTIC USE Kidney/TRANSPLANTATION Kidney Transplantation Postoperative Complications/THERAPY Sarcoma, Kaposi's/RADIOTHERAPY/*THERAPY Skin Neoplasms/RADIOTHERAPY/*THERAPY MONOGRAPH 891230
M89C0816
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Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
