Kaposi sarcoma: Difference between revisions
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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) |
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== Clinical Manifestations == |
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* Non-tender, hyperpigmented skin lesions |
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* May be macular or nodular |
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* Oral lesions in about a third |
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* May involve lymphatics, causing severe edema |
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* May involve the viscera, which may be asymptomatic or cause dyspnea (lungs), hematochezia or melena (GI tract), or other signs and symptoms |
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== Management == |
== Management == |
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* Treatment goals are symptom alleviation, prevention of disease progression, and shrinkage of |
* Treatment goals are symptom alleviation, prevention of disease progression, and shrinkage of tumour to alleviate edema, organ compromise, and psychological stress |
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=== HIV Patients === |
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* [[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 |
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* 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]] |
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* Try to decrease or stop any corticosteroids, if possible, since it appears to worsen KS |
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=== Transplant Patients === |
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* Try to include mTOR inhibitors, such as [[rapamycin]] and [[sirolimus]], in the immunosuppression regimens |
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=== Local Treatments === |
=== Local Treatments === |
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* 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 |
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** May be repeated at 3 to 4 weeks |
** May be repeated at 3 to 4 weeks |
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* Radiation therapy |
* Radiation therapy |
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* Topical alitretinoin |
* Topical [[alitretinoin]] |
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== Systemic Chemotherapy == |
=== Systemic Chemotherapy === |
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* Used in cases of advanced or rapidly-progressive disease |
* Used in cases of advanced or rapidly-progressive disease |
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* Indications include: |
* Indications include: |
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** Progression of KS on ART alone |
** Progression of KS on ART alone |
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* 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]] |
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** |
** First-line: [[liposomal doxorubicin]] 20 mg/m<sup>2</sup> every three weeks |
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** Second-line: [[paclitaxel]] |
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=== Direct Antivirals === |
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* ''In vitro'' activity of [[ganciclovir]], [[foscarnet]], and [[cidofovir]] has not translated into clinical efficacy |
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* Not recommended |
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[[Category:Oncology]] |
[[Category:Oncology]] |
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Revision as of 12:20, 2 October 2022
Background
- A tumour associated with HHV-8
- Closely associated with advanced HIV, but may also present as classic, endemic, or transplant-related KS
ACTG Staging
- Based on extent of tumour (T), immune status (I), and severity of systemic illness (S)
| Criterion | Lower Risk (0) | Higher risk (1) |
|---|---|---|
| Tumour (T) | Confined to skin and/or lymph nodes and/or minimal oral disease (non-nodular KS confined to palate) | Tumor-associated edema or ulceration; extensive oral KS; gastrointestinal KS; or KS in other non-nodal viscera |
| Immune status (I) | CD4 cell count >200/µL | CD4 cell count <200/µL |
| Systemic illness (S) | No history of OI or thrush; no "B" symptoms; and Karnofsky performance status >70 | 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
- Treatment goals are symptom alleviation, prevention of disease progression, and shrinkage of tumour to alleviate edema, organ compromise, and psychological stress
HIV Patients
- 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
- Try to decrease or stop any corticosteroids, if possible, since it appears to worsen KS
Transplant Patients
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
- May be repeated at 3 to 4 weeks
- Radiation therapy
- Topical alitretinoin
Systemic Chemotherapy
- Used in cases of advanced or rapidly-progressive disease
- Indications include:
- Symptomatic visceral involvement
- Widespread skin involvement (eg, more than 25 lesions)
- Extensive cutaneous KS that is unresponsive to local treatment
- Extensive edema
- Immune reconstitution inflammatory syndrome
- Progression of KS on ART alone
- Options include pegylated liposomal doxorubicin or liposomal daunorubicin, paclitaxel, bleomycin, vinblastine, vincristine, or etoposide
- First-line: liposomal doxorubicin 20 mg/m2 every three weeks
- Second-line: paclitaxel
Direct Antivirals
- In vitro activity of ganciclovir, foscarnet, and cidofovir has not translated into clinical efficacy
- Not recommended
References
- ^ Guglielmo Nasti, Renato Talamini, Andrea Antinori, Ferdinando Martellotta, Gaia Jacchetti, Francesco Chiodo, Giuseppe Ballardini, Laura Stoppini, Giovanni Di Perri, Maurizio Mena, Marcello Tavio, Emanuela Vaccher, Antonella D’Arminio Monforte, Umberto Tirelli. 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 Naïve From Antiretrovirals. Journal of Clinical Oncology. 2003;21(15):2876-2882. doi:10.1200/jco.2003.10.162.
- ^ Justin Stebbing, Adam Sanitt, Mark Nelson, Tom Powles, Brian Gazzard, Mark Bower. A prognostic index for AIDS-associated Kaposi's sarcoma in the era of highly active antiretroviral therapy. The Lancet. 2006;367(9521):1495-1502. doi:10.1016/s0140-6736(06)68649-2.
