Seattle Treatment Education Project: STEP Perspective - Volume 4, Number 3 - October 1992
Lori Panther, M.D.

Kaposi's Sarcoma

Epidemiologic studies. Epidemiologic evidence increasingly indicates that a sexually-transmitted agent is responsible for the development of KS. This is not synonymous with the disputed evidence for an "undetectable AIDS virus" which was the focus of media attention during the International Conference. There are small numbers of people with KS who have risk factors for HIV transmission, but are HIV-negative. A cohort of 16 people with this description was presented. Compared to a group of HIV- positive people with KS, the HIV-negative group tends to be older, with higher CD4 counts and only skin involvement with slowly progressive lesions. All 16 patients had less than 10 lesions compared to 50 percent of the HIV-positive cohort with less than 10 lesions. All 16 patients remained HIV-negative over an observation period of two years (Saltzman, USA, ThB1543).

Treatment regimens. As in any malignancy, chemotherapy has the potential benefit of delaying disease progression and prolonging life at the risk of significant toxicity. Standard systemic chemotherapy for KS currently consists of alternating weekly vincristine and vinblastine.

Several new chemotherapeutic regimens for extensive KS were presented. One new chemotherapeutic agent, liposomal daunorubicin, holds promise for decreased toxicity. Liposomal daunorubicin is a new formulation of doxorubicin, chemotherapy drug. Basically, a microscopic globule of fat is impregnated with daunorubicin. In this formulation, the drug is able to reach the diseased tissues more efficiently than a regular intravenous solution, which basically flows through the bloodstream reaching the entire body with the ability to essentially "target" the diseased tissues. Liposomal formulation of drugs generally produces less toxicity. A small number of patients taking the drug for extensive KS had the same response as those on standard chemotherapy (Dorman, USA, ThB1545). A smaller open- label study of liposomal daunorubicin in patients with extensive KS showed stable disease in 50 percent and progression in 20 percent of patients (Chew, USA, PoB3106).

Non-Hodgkins's Lymphoma

The diagnosis of NHL has one of the poorest prognoses in HIV infection, with median survival of less than one year. Good prognostic factors include CD4 counts greater than 200, good general health, lymphoma localized to the lymph nodes and absence of fevers or weight loss (Oskenhendler, France, ThB1542).

Treatment regimens. No therapeutic breakthroughs for NHL were presented at the conference. Presently, the therapy for NHL in HIV-positive people depends on the individual's personal feelings toward aggressive chemotherapy and on medical opinion of whether chemotherapy would improve quality of life. In one study was 29 very ill patients with NHL were treated with a regimen of five chemotherapeutic agents (including injection of chemotherapy into the spinal fluid), prednisone and AZT. Forty-five percent progressed, 35 percent had a partial remission initially, and overall survival was three and a half months. In this study, the chemotherapeutic regimen used did not prolong lifespan, and the addition of AZT to the chemotherapeutic regimen resulted in significantly more bone marrow toxicity (Tirelli, Italy, ThB1544). Another non-randomized unblinded study of three chemotherapeutic agents plus prednisone in 18 patients showed initial response rate of 70 percent and a median survival of five months. There was no control group for comparison (PoB3109).

Epstein-Barr virus treatment regimen

There was an interesting study presented regarding antiviral therapy as a possible treatment strategy. Epstein-Barr virus (EBV) is implicated in the pathogenesis of high-grade-B-cell lymphoma. This led researchers to study the potential inhibitory effects of two antivirals, ganciclovir and acyclovir, in mice. They concluded that ganciclovir significantly inhibited EBV-induced B- cell lymphoma, suggesting a role for ganciclovir in the prophylaxis and treatment of some lymphomas in HIV-positive individuals (PoA2362).

Copyright (c) 1992 - STEP. Noncommercial reproduction encouraged.
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Copyright © 1992 - Seattle Treatment Education Project (STEP) - All rights reserved. Noncommercial reproduction is encouraged. STEP is published four times a year by the Seattle Treatment Education Project, 127 Broadway East, 3rd Floor, Seattle, WA 98102.    Email: step100@aol.com  STEP web page