Case report with unexpected adverse events in one AIDS related Kaposi's sarcoma treated with beta human chorionic gonadotropin (BETA-HCG) (Meeting abstract).

Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.

Case report with unexpected adverse events in one AIDS related Kaposi's sarcoma treated with beta human chorionic gonadotropin (BETA-HCG) (Meeting abstract).

Proc Annu Meet Am Soc Clin Oncol; 15:A867 1996. Unique Identifier : AIDSLINE ICDB/97635867
Yamaguchi NH; Varella D; Guerra CV; Santos MA; Mazuco C; Duarte AJ; Lunardi-Iskandar Y; Bryant J; Gallo AR; Immunology Division, University of Sao Paulo Clinical Hospital,; Sao Paulo, Brazil

Abstract: AIDS related Kaposi's sarcoma (KS) is commonly observed in HIV infected homobisexual man being sex an independent risk factor. In vitro, KS malignant cells (KS Y-1) were unable to grow when incubated with BETA-HCG (Lunardi-Iskandar et al, Nature; 375:64-8 1995). Injected into the lesions, BETA-HCG induced a tumor regression likely by an apoptotic mechanism and Beta-HCG receptors were isolated on both KS malignant cells and primary tissue from HIV infected KS patients. Gill P et al reported at the LTCB meeting, that Beta-HCG demonstrated activity in patients with AIDS-KS lesions with low toxicity. We treated one 30 years old male homosexual patient with extensive cutaneous KS (NYU III) with a hard perilesional edema with BETA-HCG (APL-Wyeth) 1500 IU intralesionally in four lesions and 4000 IU IM twice, with one week interval. He had been diagnosed 7 mo before with toxoplasmosis and since that was taking AZT 300 mg/day, sulfadiazine, pyrimethamine and leucovorin with PS WHO 1, normal hepatic and renal function. He had no fever, cough or diarrhea, his CD4/CD8 counts were 30/275 respectively, Hb 12.7 g/dl, Ht 37%, Leuk 2600/mm3 Nt 71 Ly 22 Mo 7%, Plts 80000/mm3. Upper digestive tract endoscopy, chest x-rays and abdominal ultrasound were NED. After 1 wk there was a flattening and shrinkage of the injected lesions and also, of some other lesions, with disappearance of the a hard perilesional edema. 14 days after the first injection, he was admitted to the hospital with malaise, fatigue, dyspnea inferior limbs swelling and pain and fluid retention, with thoracic wall and bipalpebral edema without external signs of bleeding. Blood pressure was 110x80, P 80, T 37 C. Hb was 4.9, Ht 15, Leuk 1700, Plts 14000, normal folic acid and Vitamin B12 of 159( N200-950). Bone marrow aspiration was normo and hypocellular, with granulocytes hypocellularity with mild myelodysplastic findings, red cells hypoplasia with macroerythroblasts and normal megakaryocytes without neoplastic cells. No hemolysis or infection at that moment could be demonstrated. He presented normal kidney function but had persistent hyponatremia and hypoproteinemia with ascitis and sero-hemorrhagic pleural effusion without neoplastic cells or bacteria (pO2 of 50-60 mmHg). 15 days after admission he had right hemiparesis with normal brain CT scan, hypotension and universal edema. He received corticosteroids in the intend-to-treat some unusual cytokine releasing syndrome and in the sequence, got a respiratory infection and died, besides large spectrum antibiotics, including Tbc and P, carinii prophylaxis. In conclusion, a striking activity of the intralesional and systemic injections of BETA-HCG was reported, with some unexpected clinical and laboratory outcome not previously reported.

Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS Adult Case Report Chorionic Gonadotropin, beta Subunit, Human/*ADVERSE EFFECTS/ THERAPEUTIC USE Dyspnea/CHEMICALLY INDUCED Edema/CHEMICALLY INDUCED Fatigue/CHEMICALLY INDUCED Homosexuality, Male Human Injections, Intralesional Male Sarcoma, Kaposi's/COMPLICATIONS/*DRUG THERAPY Skin Neoplasms/COMPLICATIONS/*DRUG THERAPY ABSTRACT
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M9731529

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