Kaposi sarcoma - Revision history

Aidan at 14:14, 23 September 2024

2024-09-23T14:14:09Z

← Older revision		Revision as of 14:14, 23 September 2024
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	* However, staging only distinguishes between good risk (T0I0S0) and poor risk (literally all others), used for predicting mortality in the pre-ART era		* However, staging only distinguishes between good risk (T0I0S0) and poor risk (literally all others), used for predicting mortality in the pre-ART era
			** The 3-year survival rate of patients post-ART with T1S1 is about 50%, whereas for T0S0, T1S0, and T0S1 was all 80-90%; immune status does not appear to be predictive[[CiteRef::nasti2003ai]]
	** The 3-year survival rate of patients post-ART with T1S1 is about 50%, whereas for T0S0, T1S0, and T0S1 was all 80-90%; immune status does not appear to be predictive<ref>Nasti G, Talamini R, Antinori A, Martellotta F, Jacchetti G, Chiodo F, Ballardini G, Stoppini L, Di Perri G, Mena M, Tavio M, Vaccher E, D'Arminio Monforte A, Tirelli U; AIDS Clinical Trial Group Staging System in the Haart Era--the Italian Cooperative Group on AIDS and Tumors and the Italian Cohort of Patients Naive from Antiretrovirals. AIDS-related Kaposi's Sarcoma: evaluation of potential new prognostic factors and assessment of the AIDS Clinical Trial Group Staging System in the Haart Era--the Italian Cooperative Group on AIDS and Tumors and the Italian Cohort of Patients Naive From Antiretrovirals. J Clin Oncol. 2003 Aug 1;21(15):2876-82. doi: [https://doi.org/10.1200/JCO.2003.10.162 10.1200/JCO.2003.10.162]. PMID: [https://pubmed.ncbi.nlm.nih.gov/12885804/ 12885804].</ref>

	== Clinical Manifestations ==		== Clinical Manifestations ==
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	=== Prognostic Index ===		=== Prognostic Index ===

			* Predicts survival following the development of HAART[[CiteRef::stebbing2006a]]
	* Predicts survival following the development of HAART<ref>Stebbing J, Sanitt A, Nelson M, Powles T, Gazzard B, Bower M. A prognostic index for AIDS-associated Kaposi's sarcoma in the era of highly active antiretroviral therapy. Lancet. 2006 May 6;367(9521):1495-502. doi: [https://doi.org/10.1016/S0140-6736(06)68649-2 10.1016/S0140-6736(06)68649-2]. PMID: [https://pubmed.ncbi.nlm.nih.gov/16679162/ 16679162].</ref>

	==== Criteria ====		==== Criteria ====

Aidan at 13:03, 13 November 2022

2022-11-13T13:03:58Z

← Older revision		Revision as of 13:03, 13 November 2022
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	* A tumour associated with [[HHV-8]]		* A tumour associated with [[HHV-8]]
	* Closely associated with advanced [[HIV]], but may also present as classic, endemic, or transplant-related KS		* Closely associated with advanced [[HIV]], but may also present as classic, endemic, or transplant-related KS
			* This page is focussed on HIV-related KS

	===ACTG Staging===		===ACTG Staging===
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	* Human Herpesvirus-8 Disease. In: ''Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV''. NIH, CDC, HIVMA, and IDSA. Available at [https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/human-herpesvirus]		* Human Herpesvirus-8 Disease. In: ''Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV''. NIH, CDC, HIVMA, and IDSA. Available at [https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/human-herpesvirus]
			* Diagnosis and treatment of Kaposi's sarcoma: European consensus-based interdisciplinary guideline (EDF/EADO/EORTC). ''Eur J Cancer''. 2019;114:117-127. doi: [https://doi.org/10.1016/j.ejca.2018.12.036 10.1016/j.ejca.2018.12.036]

	[[Category:Oncology]]		[[Category:Oncology]]

Aidan: /* Clinical Manifestations */

2022-11-13T12:46:53Z

Clinical Manifestations

← Older revision		Revision as of 12:46, 13 November 2022
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	* May involve lymphatics, causing severe edema		* May involve lymphatics, causing severe edema
	* May involve the viscera, which may be asymptomatic or cause dyspnea (lungs), hematochezia or melena (GI tract), or other signs and symptoms		* May involve the viscera, which may be asymptomatic or cause dyspnea (lungs), hematochezia or melena (GI tract), or other signs and symptoms

⚫	* Treatment may cause [[IRIS]], either associated with new lesions or with worsening of existing lesions
			=== IRIS ===
		⚫	* Treatment of HIV-associated KS may cause [[IRIS]], either associated with new lesions or with worsening of existing lesions
			* May be "unmasking" (first presentation) or paradoxical worsening of pre-existing lesions
			* Risk factors for [[IRIS]] include T1 tumour stage, pre-treatment HIV viral load > 5 logs, detectable HHV-8 viremia, and initiation of ART without concurrent chemotherapy

	== Management ==		== Management ==
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	* ''In vitro'' activity of [[ganciclovir]], [[foscarnet]], and [[cidofovir]] has not translated into clinical efficacy		* ''In vitro'' activity of [[ganciclovir]], [[foscarnet]], and [[cidofovir]] has not translated into clinical efficacy
	* Not recommended		* Not recommended

			=== IRIS ===

			* Supportive care
			* Chemotherapy
			* Avoid steroids

	== Prognosis ==		== Prognosis ==

Aidan at 12:20, 11 November 2022

2022-11-11T12:20:50Z

@@ Line 73: / Line 73: @@
 * ''In vitro'' activity of [[ganciclovir]], [[foscarnet]], and [[cidofovir]] has not translated into clinical efficacy
 * Not recommended
 == Further Reading ==

Aidan: /* Further Reading */

2022-11-11T11:56:59Z

Aidan at 12:55, 2 October 2022

2022-10-02T12:55:10Z

← Older revision		Revision as of 12:55, 2 October 2022
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	* ''In vitro'' activity of [[ganciclovir]], [[foscarnet]], and [[cidofovir]] has not translated into clinical efficacy		* ''In vitro'' activity of [[ganciclovir]], [[foscarnet]], and [[cidofovir]] has not translated into clinical efficacy
	* Not recommended		* Not recommended

			== Further Reading ==

			* Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. NIH, CDC, HIVMA, and IDSA. Available at https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection

	[[Category:Oncology]]		[[Category:Oncology]]

Aidan: more staging

2022-10-02T12:49:08Z

more staging

← Older revision		Revision as of 12:49, 2 October 2022
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	\|History of OI or thrush; "B" symptoms present; Karnofsky performance status <70; or other HIV-related illness (eg, neurologic disease, lymphoma)		\|History of OI or thrush; "B" symptoms present; Karnofsky performance status <70; or other HIV-related illness (eg, neurologic disease, lymphoma)
	\|}		\|}

			* However, staging only distinguishes between good risk (T0I0S0) and poor risk (literally all others), used for predicting mortality in the pre-ART era
			** The 3-year survival rate of patients post-ART with T1S1 is about 50%, whereas for T0S0, T1S0, and T0S1 was all 80-90%; immune status does not appear to be predictive<ref>Nasti G, Talamini R, Antinori A, Martellotta F, Jacchetti G, Chiodo F, Ballardini G, Stoppini L, Di Perri G, Mena M, Tavio M, Vaccher E, D'Arminio Monforte A, Tirelli U; AIDS Clinical Trial Group Staging System in the Haart Era--the Italian Cooperative Group on AIDS and Tumors and the Italian Cohort of Patients Naive from Antiretrovirals. AIDS-related Kaposi's Sarcoma: evaluation of potential new prognostic factors and assessment of the AIDS Clinical Trial Group Staging System in the Haart Era--the Italian Cooperative Group on AIDS and Tumors and the Italian Cohort of Patients Naive From Antiretrovirals. J Clin Oncol. 2003 Aug 1;21(15):2876-82. doi: [https://doi.org/10.1200/JCO.2003.10.162 10.1200/JCO.2003.10.162]. PMID: [https://pubmed.ncbi.nlm.nih.gov/12885804/ 12885804].</ref>

	== Clinical Manifestations ==		== Clinical Manifestations ==
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	* May involve lymphatics, causing severe edema		* May involve lymphatics, causing severe edema
	* May involve the viscera, which may be asymptomatic or cause dyspnea (lungs), hematochezia or melena (GI tract), or other signs and symptoms		* May involve the viscera, which may be asymptomatic or cause dyspnea (lungs), hematochezia or melena (GI tract), or other signs and symptoms
			* Treatment may cause [[IRIS]], either associated with new lesions or with worsening of existing lesions

	== Management ==		== Management ==

Aidan at 12:20, 2 October 2022

2022-10-02T12:20:13Z

← Older revision		Revision as of 12:20, 2 October 2022
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	\|History of OI or thrush; "B" symptoms present; Karnofsky performance status <70; or other HIV-related illness (eg, neurologic disease, lymphoma)		\|History of OI or thrush; "B" symptoms present; Karnofsky performance status <70; or other HIV-related illness (eg, neurologic disease, lymphoma)
	\|}		\|}

			== Clinical Manifestations ==

			* Non-tender, hyperpigmented skin lesions
			* May be macular or nodular
			* Oral lesions in about a third
			* May involve lymphatics, causing severe edema
			* May involve the viscera, which may be asymptomatic or cause dyspnea (lungs), hematochezia or melena (GI tract), or other signs and symptoms

	== Management ==		== Management ==

	* Treatment goals are symptom alleviation, prevention of disease progression, and shrinkage of ~~tumor~~ to alleviate edema, organ compromise, and psychological stress		* Treatment goals are symptom alleviation, prevention of disease progression, and shrinkage of tumour to alleviate edema, organ compromise, and psychological stress

			=== HIV Patients ===
	* [[HIV medications\|Combination antiretroviral therapy]] is the mainstay of treatment for all patients with HIV		* [[HIV medications\|Combination antiretroviral therapy]] is the mainstay of treatment for all patients with HIV
	* Disease may worsen for 3 to 6 weeks following initiation of ART, due to [[immune reconstitution inflammatory syndrome]]		* Disease may worsen for 3 to 6 weeks following initiation of ART, due to [[immune reconstitution inflammatory syndrome]]
			* Try to decrease or stop any corticosteroids, if possible, since it appears to worsen KS

			=== Transplant Patients ===

			* Try to include mTOR inhibitors, such as [[rapamycin]] and [[sirolimus]], in the immunosuppression regimens

	=== Local Treatments ===		=== Local Treatments ===
	* Intralesional vinblastine 0.2 to 0.3 mg/mL solution with a volume of 0.1 mL per 0.5 cm2 of lesion		* Intralesional [[vinblastine]] 0.2 to 0.3 mg/mL solution with a volume of 0.1 mL per 0.5 cm2 of lesion
	** May be repeated at 3 to 4 weeks		** May be repeated at 3 to 4 weeks
	* Radiation therapy		* Radiation therapy
	* Topical alitretinoin		* Topical [[alitretinoin]]

	== Systemic Chemotherapy ==		=== Systemic Chemotherapy ===
	* Used in cases of advanced or rapidly-progressive disease		* Used in cases of advanced or rapidly-progressive disease
	* Indications include:		* Indications include:
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	** Progression of KS on ART alone		** Progression of KS on ART alone

	* Options include pegylated liposomal doxorubicin or liposomal daunorubicin, paclitaxel, bleomycin, vinblastine, vincristine, or etoposide		* Options include [[pegylated liposomal doxorubicin]] or [[liposomal daunorubicin]], [[paclitaxel]], [[bleomycin]], [[vinblastine]], [[vincristine]], or [[etoposide]]
	** ~~Pegylated~~ liposomal doxorubicin 20 mg/m2 every three weeks		** First-line: [[liposomal doxorubicin]] 20 mg/m<sup>2</sup> every three weeks
			** Second-line: [[paclitaxel]]

			=== Direct Antivirals ===

			* ''In vitro'' activity of [[ganciclovir]], [[foscarnet]], and [[cidofovir]] has not translated into clinical efficacy
			* Not recommended

	[[Category:Oncology]]		[[Category:Oncology]]

Aidan: /* Systemic Chemotherapy */

2022-10-01T18:11:12Z

Systemic Chemotherapy

← Older revision		Revision as of 18:11, 1 October 2022
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	* Used in cases of advanced or rapidly-progressive disease		* Used in cases of advanced or rapidly-progressive disease
	* Indications include:		* Indications include:
		⚫	** Symptomatic visceral involvement
	** Widespread skin involvement (eg, more than 25 lesions)		** Widespread skin involvement (eg, more than 25 lesions)
	** Extensive cutaneous KS that is unresponsive to local treatment		** Extensive cutaneous KS that is unresponsive to local treatment
	** Extensive edema		** Extensive edema
⚫	** Symptomatic visceral involvement
	** Immune reconstitution inflammatory syndrome		** Immune reconstitution inflammatory syndrome
	** Progression of KS on ART alone		** Progression of KS on ART alone

Aidan at 17:48, 1 October 2022

2022-10-01T17:48:54Z

← Older revision		Revision as of 17:48, 1 October 2022
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	==Background==		==Background==
	* A tumour associated with [[HHV-8]]		* A tumour associated with [[HHV-8]]
	* Closely associated with advanced [[HIV]]		* Closely associated with advanced [[HIV]], but may also present as classic, endemic, or transplant-related KS

	===ACTG Staging===		===ACTG Staging===

← Older revision		Revision as of 11:56, 11 November 2022
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	== Further Reading ==		== Further Reading ==

	* Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. NIH, CDC, HIVMA, and IDSA. Available at https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-~~infection~~		* Human Herpesvirus-8 Disease. In: ''Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV''. NIH, CDC, HIVMA, and IDSA. Available at [https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/human-herpesvirus]

	[[Category:Oncology]]		[[Category:Oncology]]