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) |
Management
- Treatment goals are symptom alleviation, prevention of disease progression, and shrinkage of tumor to alleviate edema, organ compromise, and psychological stress
- 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
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:
- Widespread skin involvement (eg, more than 25 lesions)
- Extensive cutaneous KS that is unresponsive to local treatment
- Extensive edema
- Symptomatic visceral involvement
- Immune reconstitution inflammatory syndrome
- Progression of KS on ART alone
- Options include pegylated liposomal doxorubicin or liposomal daunorubicin, paclitaxel, bleomycin, vinblastine, vincristine, or etoposide
- Pegylated liposomal doxorubicin 20 mg/m2 every three weeks
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.
