Sarcoma kaposiego

Sarcoma kaposiego
Leczenie

Sarcoma Kaposiego (SK) to nowotwór naczyniopochodny wywodzący się z komórek śródbłonka naczyń limfatycznych i krwionośnych, wywoływany przez HHV-8. Leczenie SK jest zindywidualizowane i zależy od typu (epidemiczny związany z HIV, klasyczny, endemiczny, jatrogenny), lokalizacji i rozległości zmian oraz stanu immunologicznego pacjenta. W SK związanym z HIV podstawą terapii jest HAART, która u około 40% pacjentów powoduje regresję zmian. W bardziej zaawansowanych przypadkach stosuje się chemioterapię, najczęściej doksorubicynę liposomalną lub paklitaksel, co poprawia skuteczność leczenia. W SK jatrogennym, szczególnie po przeszczepach, zaleca się redukcję immunosupresji oraz zamianę inhibitorów kalcyneuryny na sirolimus, który wykazuje działanie przeciwnowotworowe. Klasyczne i endemiczne SK zwykle ograniczają się do skóry i są leczone miejscowo, m.in. radioterapią (20-30 Gy), krioterapią, chirurgią czy terapią miejscową (imiquimod, alitretynoina). Radioterapia cechuje się wysoką skutecznością, z odpowiedzią sięgającą 100% i remisjami 30-90%.

Leczenie Sarcoma Kaposiego

Sarcoma Kaposiego (SK) jest nowotworem naczyniopochodnym, wywodzącym się z komórek śródbłonka naczyń limfatycznych i krwionośnych, wywoływanym przez ludzki herpeswirus typu 8 (HHV-8). Choroba ta może dotykać skóry, błon śluzowych, węzłów chłonnych oraz narządów wewnętrznych. Obecnie nie istnieje metoda leczenia, która całkowicie eliminowałaby HHV-8, dlatego też nie można mówić o pełnym wyleczeniu sarcoma Kaposiego. Terapia ma na celu głównie łagodzenie objawów, kontrolowanie choroby oraz spowolnienie jej progresji.¹²

Wybór metody leczenia zależy od wielu czynników, w tym od typu SK (epidemiczny związany z HIV, klasyczny, endemiczny lub jatrogenny), lokalizacji i rozległości zmian, obecności objawów, stanu układu immunologicznego pacjenta oraz ogólnego stanu zdrowia.¹² Leczenie jest zazwyczaj prowadzone przez zespół specjalistów, który tworzy indywidualny plan terapeutyczny dla każdego pacjenta.

Leczenie SK związanego z HIV

W przypadku SK związanego z HIV (epidemicznego) podstawową metodą leczenia jest terapia antyretrowirusowa, zwana HAART (Highly Active Antiretroviral Therapy).¹ HAART zmniejsza poziom wirusa HIV we krwi, wzmacnia układ odpornościowy, co prowadzi do obniżenia poziomu HHV-8 i może przyczynić się do regresji zmian SK. U około 40% pacjentów z SK związanym z AIDS, zmiany ulegają zmniejszeniu po rozpoczęciu terapii HAART.² W wielu przypadkach HAART może być jedyną potrzebną formą leczenia, szczególnie u pacjentów z ograniczonymi zmianami skórnymi i dobrze funkcjonującym układem immunologicznym.¹²

U pacjentów z bardziej zaawansowaną chorobą, HAART często łączy się z chemioterapią. Kombinacja ta wykazuje większą skuteczność niż każda z tych metod stosowana osobno.¹ Pacjenci z rozległymi zmianami skórnymi, objawami ze strony narządów wewnętrznych lub szybko postępującą chorobą mogą wymagać dodatkowego leczenia systemowego.

Leczenie SK jatrogennego

Sarcoma Kaposiego związane z immunosupresją (jatrogenne), występujące najczęściej u pacjentów po przeszczepieniach narządów, zwykle reaguje na zmniejszenie lub przerwanie terapii immunosupresyjnej.¹ W jednym z badań, u 9 z 20 pacjentów obserwowano całkowitą lub częściową regresję SK po zmniejszeniu dawki leków immunosupresyjnych.²

Kilka badań retrospektywnych i prospektywnych wykazało korzyści z zamiany inhibitorów kalcyneuryny (np. cyklosporyny, takrolimusu) na inhibitor mTOR, szczególnie sirolimus.³¹ Sirolimus ma udowodnione działanie przeciwnowotworowe w przypadku SK i jest zalecany jako leczenie pierwszego rzutu po przeszczepieniu narządu.⁴

Leczenie SK klasycznego i endemicznego

Klasyczne SK oraz endemiczne SK u dorosłych pacjentów zazwyczaj ogranicza się do skóry i ma łagodny przebieg. Z tego powodu, leczenie obu typów jest podobne.¹ Leczenie klasycznego SK często obejmuje terapię miejscową, gdyż choroba rozwija się powoli i może nie wymagać natychmiastowego leczenia.¹

W przypadku bardziej rozległej choroby może być stosowana chemioterapia. Ponieważ klasyczne SK jest rzadką chorobą w Stanach Zjednoczonych i zazwyczaj jest początkowo leczone radioterapią, niewielka liczba pacjentów została poddana chemioterapii. Jej stosowanie w klasycznym SK opiera się na danych ekstrapolowanych z leczenia SK związanego z AIDS, a brak jest randomizowanych prospektywnych badań porównujących jednego leku z drugim w klasycznym SK.²

Leczenie endemicznego SK jest podobne do klasycznego, jednak ze względu na to, że występuje w krajach o ograniczonych zasobach, opcje leczenia mogą być bardziej ograniczone.²¹

Metody leczenia miejscowego

Leczenie miejscowe jest odpowiednie dla pacjentów, którzy wymagają łagodzenia miejscowo zaawansowanej objawowej choroby lub dla tych, którzy mają kosmetycznie nieakceptowalne zmiany.¹ Opcje leczenia miejscowego obejmują:

Radioterapia

Radioterapia jest najszerzej stosowaną i najskuteczniejszą terapią miejscową w leczeniu SK.²¹ Wykorzystuje wysokoenergetyczne promienie rentgenowskie lub inne rodzaje promieniowania do niszczenia komórek nowotworowych lub hamowania ich wzrostu.¹

W przypadku pojedynczych zmian lub zmian o ograniczonym zasięgu, umiarkowane dawki promieniowania stosowane z ograniczonym marginesem zapewniają doskonałą kontrolę choroby w leczonej okolicy.³ Radioterapia jest szczególnie skuteczna w leczeniu SK, z częstością odpowiedzi sięgającą 100% i częstością całkowitych remisji od 30% do 90%.² Stosowana dawka promieniowania zazwyczaj wynosi od 20 do 30 Gy.¹¹

Radioterapia jest również skuteczna w łagodzeniu objawów związanych z SK, takich jak ból, krwawienie i obrzęk.¹ Obrzęk limfatyczny kończyn dolnych związany z SK często reaguje na leczenie radioterapią dostarczaną w pojedynczej serii lub na chemioterapię systemową.¹

Chirurgia

Chirurgiczne usunięcie może być korzystne dla pacjentów z małymi powierzchownymi zmianami.³ Metody chirurgiczne obejmują:

Miejscowe wycięcie: Nowotwór jest wycinany ze skóry wraz z małą ilością normalnej tkanki wokół niego.¹
Elektrodessykacja i łyżeczkowanie: Guz jest usuwany ze skóry za pomocą łyżeczki (ostrego, łyżkokształtnego narzędzia). Następnie używa się elektrody igłowej do leczenia obszaru prądem elektrycznym, który zatrzymuje krwawienie i niszczy komórki nowotworowe pozostające na krawędzi rany.²

¹²

Warto zauważyć, że po chirurgicznym wycięciu prawdopodobne jest wystąpienie miejscowej wznowy. Jednak wielokrotne małe wycięcia mogą być nadal wykonywane w celu dobrej kontroli choroby.⁴

Krioterapia

Krioterapia to leczenie, które wykorzystuje ciekły azot lub inne skrajnie chłodne chemikalia do zamrażania i niszczenia zainfekowanych tkanek.¹¹ Jest to metoda, która może być przydatna szczególnie dla małych zmian twarzy o wymiarach mniejszych niż 1 cm.⁴

Terapia intralezyjna

Terapia intralezyjna z alkaloidami Vinca z winkrystyną lub winblastyną w małych dawkach, a także bleomycyną, była stosowana w ograniczonym zakresie, głównie w przypadku klasycznej postaci sarcoma Kaposiego.⁵ Chemioterapia intralezyjna może zmniejszyć zmiany skórne i sprawić, że staną się jaśniejsze. Czasami może nawet prowadzić do całkowitego zniknięcia zmian.¹

Terapia miejscowa z użyciem kremów

Imiquimod, miejscowy modulator odpowiedzi immunologicznej, wykazał bezpieczeństwo i skuteczność u pacjentów z ograniczonym skórnym klasycznym lub związanym z przeszczepieniem SK.⁶ Najczęściej stosowanym leczeniem wczesnych zmian skórnych jest krem, który aplikuje się bezpośrednio na skórę. Może to być:

krem immunoterapeutyczny imiquimod (Aldara), który jest stosowany do leczenia niektórych nowotworów skóry, jest najczęstszym leczeniem
krem alitretynoina 0,1% (Panretin), który jest rodzajem kremu retynoidowego (podobnego do witaminy A), jest czasami stosowany²

Miejscowe terapie pomagają poprawić istniejące zmiany, ale nie zapobiegają rozwojowi nowych.²

Leczenie systemowe

Leczenie systemowe jest wskazane w przypadku objawowej choroby trzewnej lub szybko postępującej choroby śluzówkowo-skórnej, dla której pożądana jest szybka odpowiedź. Jest stosowane w rozsianej chorobie, która nie poddaje się terapiom miejscowym.²

Chemioterapia systemowa

Chemioterapia wykorzystuje leki do zatrzymania wzrostu komórek nowotworowych, albo przez ich zabijanie, albo przez zatrzymanie ich podziału.¹ Obecne wytyczne National Comprehensive Cancer Network (NCCN) zalecają stosowanie doksorubicyny liposomalnej (lub daunorubicyny liposomalnej) lub paklitakselu w leczeniu pierwszego rzutu. Sirolimus jest zalecany jako leczenie pierwszego rzutu po przeszczepieniu narządu.⁵

Dostępne opcje chemioterapii obejmują:

Doksorubicyna liposomalna (Doxil, Caelyx) – może być najbardziej aktywnym lekiem w leczeniu SK i ma tę zaletę, że powoduje mniejsze uszkodzenie serca niż standardowa doksorubicyna.¹¹ Połączenie terapii antyretrowirusowej i liposomalnej doksorubicyny skutkowało 5-letnim całkowitym odsetkiem przeżyć na poziomie 85% u 140 pacjentów z chorobą T1.²
Paklitaksel (Taxol) – lek stosowany w leczeniu zaawansowanego SK.¹ Aktywność przeciwnowotworowa i bezpieczeństwo taksanów były oceniane głównie u pacjentów z klasycznym SK i SK związanym z AIDS, z ogólną odpowiedzią zmian skórnych w zakresie od 40 do 65%.¹
Inne chemioterapeutyki – m.in. winorelbina, etopozyd, gemcytabina, bleomycyna, winblastyna, winkrystyna, które mogą być rozważane w kolejnych liniach leczenia.²¹

Technologia liposomalna skutkowała wyższymi odsetkami odpowiedzi przy mniejszej kardiotoksyczności i mielotoksyczności dla liposomalnej doksorubicyny i liposomalnej daunorubicyny.²

Immunoterapia

Immunoterapia to leczenie, które wykorzystuje układ odpornościowy pacjenta do walki z nowotworem.¹ Interferony alfa były szeroko badane i wykazują 40% obiektywny odsetek odpowiedzi u pacjentów z SK związanym z AIDS.³ Aktywność kliniczna interferonu alfa w SK może być mediowana przez jego właściwości antyangiogenne, przeciwwirusowe i immunomodulujące.¹

Leki immunomodulujące, takie jak talidomid, pomalidomid i lenalidomid, również wykazały skuteczność w leczeniu SK.²¹ Pomalidomid jest teratogenny, przepisywany w ramach programu oceny ryzyka i strategii minimalizacji ryzyka (REMS), i powinien być podawany z aspiryną w celu zmniejszenia ryzyka żylnej choroby zakrzepowo-zatorowej.⁴ FDA zatwierdziła pomalidomid (Pomalyst) do leczenia SK związanego z AIDS po niepowodzeniu HAART oraz SK u pacjentów dorosłych, którzy są HIV-negatywni.¹

Terapia celowana

Ze względu na wysoce naczyniowy charakter SK, choroba ta jest uważana za naturalny cel dla inhibicji angiogenezy.³ Badane są nowe terapie celowane, w tym leki hamujące czynniki wzrostu śródbłonka naczyniowego (VEGF), inhibitory kinazy tyrozynowej, inhibitory metaloproteinaz macierzy i wiele szlaków sygnałowych cząsteczek.¹

Bewacyzumab jest inhibitorem VEGF, który był badany w SK związanym z AIDS.⁴ Inhibitory szlaku mTOR, takie jak sirolimus (rapamycyna) i temsyrolimus, także wykazały aktywność w stosunku do SK.²

Wybór metody leczenia

Decyzje dotyczące leczenia SK są zindywidualizowane i zależą od wielu czynników, w tym od funkcji układu odpornościowego oraz liczby, lokalizacji i rozmiaru zmian SK.¹ Ogólne podejście do leczenia różnych form SK jest następujące:

Leczenie SK z pojedynczymi zmianami skórnymi

W przypadku pojedynczych, małych zmian skórnych, odpowiednie są następujące metody leczenia:

Radioterapia miejscowa
Chirurgiczne wycięcie
Krioterapia
Terapia intralezyjna (np. winkrystyna, bleomycyna)
Terapia miejscowa (alitretynoina, imikwimod)¹¹

Leczenie SK z wieloma zmianami skórnymi

W przypadku licznych zmian skórnych lub zmian występujących na całym ciele, odpowiednie są następujące metody leczenia:

Radioterapia
Chemioterapia systemowa
Elektochemioterapia²³

Leczenie SK zajmującego węzły chłonne lub narządy wewnętrzne

W przypadku SK, który zajmuje węzły chłonne lub przewód pokarmowy, leczenie zazwyczaj obejmuje chemioterapię z radioterapią lub bez niej.³ Zalecane są następujące metody:

Chemioterapia systemowa (doksorubicyna liposomalna, paklitaksel)
Radioterapia
HAART (w przypadku SK związanego z HIV)¹¹

Nowe kierunki w leczeniu SK

Prowadzone są badania kliniczne nowych metod leczenia SK, w tym:

Inhibitory angiogenezy – biorąc pod uwagę kluczową rolę angiogenezy w patogenezie SK, terapie antyangiogenne stanowią potencjalne cele terapeutyczne i mogą być alternatywą dla chemioterapii.¹
Blokada punktów kontrolnych układu immunologicznego – to interesujące alternatywne podejście terapeutyczne poprzez przywrócenie odporności przeciwko HHV-8 i poprawę kontroli guza.¹
Celowane terapie molekularne – takie jak przeciwciała monoklonalne i inhibitory kinazy tyrozynowej.¹

Podsumowanie leczenia SK

Leczenie sarcoma Kaposiego jest kompleksowe i wymaga indywidualnego podejścia. Kluczowe jest wzmocnienie funkcji układu odpornościowego, szczególnie u pacjentów z HIV lub po przeszczepieniu narządów. W zależności od typu SK, rozległości choroby i stanu pacjenta, stosuje się różne kombinacje terapii miejscowej, radioterapii, chemioterapii i immunoterapii.¹

Chociaż SK nie jest obecnie całkowicie uleczalne, właściwe leczenie może kontrolować chorobę przez wiele lat, zmniejszyć objawy i poprawić jakość życia pacjentów. Regularne monitorowanie jest kluczowe dla śledzenia postępu choroby i wykrywania wszelkich nawrotów lub powikłań.¹

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Materiały źródłowe

#1 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Currently, no treatment is available to eradicate HHV-8 infection. Therefore, there is no cure for Kaposi sarcoma (KS). Instead, the purpose of therapy in all forms of KS is directed at alleviating symptoms and slowing disease progression. Treatment decisions vary depending on KS form, presence of symptoms, and extent of disease. […] Lower extremity edema can be managed with compression stockings. Local therapies, including surgical resection, radiotherapy, cryotherapy, and intralesional chemotherapy, can be used to treat symptomatic or cosmetically unacceptable lesions. Systemic chemotherapy should be reserved for patients in whom local therapy fails or who have extensive disease. […] Therapy for epidemic Kaposi sarcoma centers on the use of highly active antiretroviral therapy (HAART), which has decreased the incidence and severity of this disease. Most good-risk patients show tumor regression with HAART alone. Local therapies can also be implemented for symptomatic or cosmetically disfiguring cutaneous lesions. The least invasive and toxic modality should be used due to high risk for infectious complications in this population. Poor-risk patients usually require a combination of chemotherapy with HAART. Treatment is typically continued until response plateau or unacceptable toxicity.
#1 Kaposi’s sarcoma | Soft tissue sarcoma |Cancer Research UK
https://www.cancerresearchuk.org/about-cancer/soft-tissue-sarcoma/types/which-treatments-are-used-for-kaposis-sarcoma
Your treatment depends on: the type of KS, the size and location of the lesions, how severe it is, your general health. […] Treatment options for all types of KS might include one or more of the following, depending on whether the lesions are localised or widespread: freezing the area with liquid nitrogen (cryotherapy), laser treatment, removing the lesions with a small operation, radiotherapy to the lesions, creams applied to the lesions (topical therapy), chemotherapy into your bloodstream, an immunotherapy called interferon alfa. […] Additional treatments for transplant related KS include stopping an immunosuppressant drug or changing the dose. Or using an immunosuppressant drug called sirolimus that prevents rejection of a kidney after a kidney transplant. […] An additional treatment for AIDS related KS includes antiretroviral therapy. This works by stopping HIV from reproducing. It can reduce your levels of HIV and keeps your immune system healthy.
#1 Kaposi’s sarcoma – Wikipedia
https://en.wikipedia.org/wiki/Kaposi%27s_sarcoma
Kaposi sarcoma is not curable, but it can often be treatable for many years. In KS associated with immunodeficiency or immunosuppression, treating the cause of the immune system dysfunction can slow or stop the progression of KS. In 40% or more of patients with AIDS-associated Kaposi sarcoma, the Kaposi lesions will shrink upon first starting highly active antiretroviral therapy (HAART). Therefore, HAART is considered the cornerstone of therapy in AIDS-associated Kaposi sarcoma. […] People with a few local lesions can often be treated with local measures such as radiation therapy or cryosurgery. Weak evidence suggests that antiretroviral therapy in combination with chemotherapy is more effective than either of those two therapies individually. Limited basic and clinical evidence suggest that topical beta-blockers, such as timolol, may induce regression of localized lesions in classic as well as HIV-associated Kaposi sarcoma.
#1 Kaposiâs sarcoma and HIV | aidsmap
https://www.aidsmap.com/about-hiv/kaposis-sarcoma-and-hiv
Kaposis sarcoma usually appears as lesions on the skin or on mucosal surfaces (like inside the mouth or genitals). […] HIV treatment protects against Kaposis sarcoma and slows down disease progression. […] People with advanced Kaposis sarcoma may also need chemotherapy. […] HIV treatment is an essential part of managing Kaposis sarcoma in people living with HIV. If you are not already taking HIV treatment, you will be strongly recommended to start. […] HIV treatment strengthens the immune system, protects against KS, slows down KS disease progression and prolongs survival. […] For many people with KS, this is the only treatment they need. […] Localised treatment can also be used, primarily to enhance physical appearance. […] Chemotherapy may be recommended if you have KS that is likely to develop rapidly
#1 Kaposi sarcoma
https://dermnetnz.org/topics/kaposi-sarcoma
HAART plus chemotherapy is found to be more effective than HAART alone or chemotherapy alone in treating Kaposi sarcoma. […] Iatrogenic Kaposi sarcoma may improve or clear if it is possible to stop the immune suppressive medication. […] The choice of a more specific treatment depends mainly on the extent of the disease. […] Small, localised lesions are generally only treated if they are painful or they are causing cosmetic problems. […] Treatments include: Cryotherapy with liquid nitrogen, Radiotherapy. This is most useful for classic Kaposi sarcoma and is less effective for HIV-associated disease, Surgical excision of individual nodules, Laser therapy using pulsed dye laser or pulsed carbon dioxide laser, Injection with anti-cancer drugs such as vinblastine, Topical application of alitretinoin gel (Panretin). This drug is not yet available in New Zealand, Electrochemotherapy, a new treatment that uses electrical impulses to enhance effectiveness of bleomycin or cisplatin injected into tumours.
#1 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Iatrogenic or post-transplantation Kaposi sarcoma commonly responds to reduction or discontinuation of immunosuppression. In one study, tapering of immunosuppressive therapy alone led to complete or partial KS regression in 9 of 20 patients. […] Several retrospective and prospective studies have shown a benefit of switching from calcineurin inhibitors (eg, cyclosporine, tacrolimus) to a mammalian target of rapamycin (mTOR) inhibitor, specifically sirolimus. […] Chemotherapy is the preferred first-line therapy for refractory/relapsed limited cutaneous disease and advanced disease. It is indicated for symptomatic visceral or rapidly progressive mucocutaneous disease for which a rapid response is desirable. It is used in disseminated disease not amenable to local modalities. […] Current National Comprehensive Cancer Network (NCCN) guidelines recommend liposomal doxorubicin (or liposomal daunorubicin) or paclitaxel in the first-line setting. Sirolimus is the first-line recommendation following an organ transplant.
#1 General Considerations in the Treatment of Kaposi Sarcoma | American Cancer Society
https://www.cancer.org/cancer/types/kaposi-sarcoma/treating/general-considerations.html
Chemotherapy may be used for widespread skin lesions or for KS that is in the lymph nodes, the lungs, or the digestive tract. Liposomal anthracyclines or paclitaxel are the drugs most often used for chemotherapy. […] In people who have had organ transplants, KS lesions sometimes go away on their own if the drugs that suppress the immune system are changed or stopped. A drug called sirolimus may be used in place of another anti-rejection drug because it can often make KS lesions get smaller. […] Skin lesions can be treated with radiation therapy or another local treatment. Most doctors try to avoid giving chemotherapy in KS patients who have had organ transplants. But some patients may agree to take part in clinical trials of new drugs. […] Because endemic KS occurs in poor countries, treatment options are often limited. When available, the same treatments given for classic KS may be used.
#1 Kaposi Sarcoma Treatment (PDQÂ®): Treatment – Health Professional Information [NCI]
https://www.columbiadoctors.org/health-library/nci-pdq-cancer/kaposi-sarcoma-treatment-pdq-treatment-health-professional-information-nci/
Kaposi sarcoma (KS) was first described in 1872 by the Hungarian dermatologist, Moritz Kaposi. […] The use of antiretroviral therapy for patients with AIDS-associated KS has been associated with a sustained and substantial decline in KS incidence in multiple large cohorts. […] Transplant-related KS (also called iatrogenic KS) is diagnosed in patients who are therapeutically immunosuppressed, such as after an organ transplant. […] Classic Kaposi sarcoma (KS), as well as endemic KS in adult patients, is usually limited to the skin and has an indolent course. Thus, management for both is typically similar. […] Treatment options for localized skin disease include the following (options are equivalent): Radiation therapy, Surgery, Other options (cryo-laser, intralesional, and topical therapy).
#1 Kaposi’s sarcoma | Macmillan Cancer Support
https://www.macmillan.org.uk/cancer-information-and-support/soft-tissue-sarcoma/kaposis-sarcoma
Classic or endemic Kaposis may not need to be treated straight away. This is because it grows slowly and may not cause any problems. Chemotherapy or local treatments may be used if classic Kaposis starts to grow or spread more quickly or affects a number of areas. […] This type of Kaposis can sometimes be controlled by stopping or changing the immunosuppressant drugs you are taking. If this does not work, you may need treatment with chemotherapy or radiotherapy.
#1 Kaposi Sarcoma – Rare Cancers Australia
https://www.rarecancers.org.au/knowledgebase/cancer-types/kaposi-sarcoma/
Treatments for Endemic KS are generally the same as classical treatment options. However, as this type of cancer is frequent in poorer countries, treatment options available may be limited. Treatment options may include: Surgery, potentially including: Tumour excision, Curettage and electrodesiccation, Chemotherapy, Radiation therapy, Cryotherapy, Photodynamic therapy, Clinical trials, Palliative care, Complimentary therapies. […] Patients with Iatrogenic KS may simply involve stopping or switching the immune-supressing drugs taken after their transplant, if possible to do so. Other treatment options may include: Surgery, potentially including: Tumour excision, Curettage and electrodesiccation, Radiation therapy, Cryotherapy, Photodynamic therapy. Chemotherapy is not generally given to patients with Iatrogenic KS.
#1 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Bevacizumab is a VEGF inhibitor that has been studied in AIDS-associated Kaposi sarcoma. […] Local therapy is best suited for patients who require palliation of locally advanced symptomatic disease (eg, radiation) or for those who have cosmetically unacceptable lesions. […] Radiation therapy is the most widely used and effective local therapy. […] Surgical excision may be of benefit for patients with small superficial lesions. […] Intralesional therapy with vinca alkaloids with low-dose vincristine or vinblastine as well as bleomycin has been used in a limited fashion primarily for the classic form of Kaposi sarcoma. […] Cryotherapy entails liquid nitrogen applied topically and may be useful for small facial lesions less than 1 cm in dimensions. […] Imiquimod, a topical immune response modulator, has shown safety and efficacy in patients with limited cutaneous classic or transplant-associated Kaposi sarcoma.
#1 Localized Radiotherapy for Classic Kaposiâs Sarcoma: An Analysis of Lesion Characteristics and Treatment Response
https://www.mdpi.com/2072-6694/16/18/3194
RT is widely recognized as the primary treatment for localized KS, with reported overall response rates of up to 100% and CR rates ranging from 30% to 90%. […] In our study, localized symptomatic lesions treated with RT showed excellent efficacy, achieving a 100% overall response rate and complete symptom resolution. […] Further research is needed to determine the optimal RT dose and fractionation.
#1 Kaposi Sarcoma Treatment (PDQ®): Treatment – Patient Information [NCI]
https://www.cham.org/HealthwiseArticle.aspx?id=ncicdr0000442381
Kaposi sarcoma is a disease in which malignant lesions (cancer) can form in the skin, mucous membranes, lymph nodes, and other organs. […] There are different types of treatment for patients with Kaposi sarcoma. […] The following types of treatment are used to treat Kaposi sarcoma: […] Treatment of epidemic Kaposi sarcoma combines treatment for Kaposi sarcoma with treatment for acquired immunodeficiency syndrome (AIDS). […] Highly active antiretroviral therapy (HAART) is a combination of several drugs used to lessen the damage to the immune system caused by human immunodeficiency virus (HIV) infection. […] Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] The following surgical procedures may be used for Kaposi sarcoma to treat small, surface lesions:
#1 Kaposi Sarcoma Treatment (PDQÂ®) – NCI
https://www.cancer.gov/types/soft-tissue-sarcoma/hp/kaposi-treatment-pdq
Small localized lesions of KS may be treated by electrodesiccation and curettage, cryotherapy, or by surgical excision. KS tumors are also generally very responsive to local radiation therapy, and excellent palliation has been obtained with doses at 20 Gy or slightly higher. […] The combination of antiretroviral therapy and liposomal doxorubicin resulted in a 5-year overall survival rate of 85% in 140 patients with T1 disease. […] The interferon alfas have also been widely studied and show a 40% objective response rate in patients with AIDS-associated KS. […] Pomalidomide is teratogenic, prescribed through a Risk Evaluation and Mitigation Strategy (REMS) program, and it should be given with aspirin to mitigate venous thromboembolism risk.
#1 Localized Radiotherapy for Classic Kaposiâs Sarcoma: An Analysis of Lesion Characteristics and Treatment Response
https://www.mdpi.com/2072-6694/16/18/3194
The overall response rate after RT for KS was calculated as the sum of the CR and PR rates. […] The primary endpoint was the effectiveness of RT for KS. […] The median dose was 30 Gy (range, 20â54 Gy), using fraction sizes of 1.8â5 Gy. […] The overall response rate for all treated lesions was 100%, with 92.8% (64/69) of them achieving CR and 7.2% (5/69) showing PR. […] The effectiveness of RT was evident, even in cases involving disseminated lesions. […] The treatment of KS often involves RT, chemotherapy, and, in cases such as AKS, a combination of antiretroviral therapy, each requiring specific expertise. […] Localized symptomatic lesions often respond well to local treatments such as RT, excision, topical agents, cryotherapy, intralesional chemotherapy, and electrochemotherapy.
#1 Palliative treatment of Kaposi sarcoma with radiotherapy: a single center experience
https://www.e-roj.org/journal/view.php?number=1478
The aim of this study is to evaluate the treatment responses of Kaposi sarcoma patients treated with radiotherapy (RT). […] RT is an effective local treatment which is frequently preferred in palliative treatment of KS. […] KS is radiosensitive and response rates to treatment are reported as high as 70%95%. […] In this study, we aimed to investigate the treatment response and visual response of the lesion in patients with KS who underwent extremity RT for palliative purposes. […] The primary endpoint of the study was to assess whether patients had adequate palliation (patients reported outcomes after RT) on their complaints. […] The main indications for palliative RT are bleeding, pain, pruritus, and edema. […] In conclusion, RT is an effective local treatment and high response rates in the treatment of KS. The subjective response rate was higher in male sex, whereas visual response was higher in electron treatments and 20 Gy per 5 fractions scheme. Additional studies are needed to make RT dose and techniques standard.
#1 Current Therapeutic Options for Kaposi’s Sarcoma
https://www.cancernetwork.com/view/current-therapeutic-options-kaposis-sarcoma
Treatment options for patients with acquired immune deficiency syndrome (AIDS)-related Kaposi’s sarcoma (KS) have changed very little over the past decade. […] At present, available options include radiation therapy, chemotherapy, and biologic response modifiers. […] Improved delivery systems for existing chemotherapeutic agents may help to target more effective doses to KS lesions and to prevent certain dose-limiting side effects. […] For patients with one or a few isolated KS lesions, commonly used local interventions include spot radiation or laser therapy, intralesional chemotherapy, or cryotherapy. […] KS-associated lymphedema of the extremities often responds to radiation treatment delivered in a single course or to systemic chemotherapy. […] Chemotherapeutic agents in wide use include the vinca alkaloids, bleomycin (Blenoxane), doxorubicin, and etoposide (VP-16 [VePesid]).
#1 Kaposi Sarcoma – Cancer Information – Oncology Hematology Care – OHC
https://ohcare.com/condition/kaposi-sarcoma/
Kaposi sarcoma is a cancer that causes lesions (abnormal tissue) to grow in the skin, the mucous membranes lining the mouth, nose and throat, lymph nodes or other organs. […] There are four types of standard treatment. Your OHC doctor will help you determine the best care plan for you. […] Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] The following surgical procedures may be used for Kaposi sarcoma to treat small, surface lesions: Local excision: The cancer is cut from the skin along with a small amount of normal tissue around it. […] Electrodesiccation and curettage: The tumor is cut from the skin with a curette (a sharp, spoon-shaped tool). A needle-shaped electrode is then used to treat the area with an electric current that stops the bleeding and destroys cancer cells that remain around the edge of the wound. The process may be repeated one to three times during the surgery to remove all of the cancer.
#1 Azthena logo with the word Azthena
https://www.news-medical.net/health/Treatment-of-Kaposis-sarcoma.aspx
Radiotherapy employs high energy beams to destroy the lesions. […] For radiotherapy, multiple hospital visits are needed. […] Endemic or African Kaposi’s sarcoma is generally treated with chemotherapy. […] If there are small lesions drugs may be injected into the lesion. […] Intralesional chemotherapy can shrink skin lesions and make them lighter in colour. […] Common side effects include loss of appetite, loss or hair, weakness, anemia, propensity to get infections, nausea, bleeding tendencies, sore mouth ulcers etc. […] Kaposi’s sarcoma after an organ transplant is controlled by stopping or changing the immunosuppressant drugs. […] If the symptoms do not resolve then treatment with chemotherapy or radiotherapy should be initiated. […] This is a procedure that uses liquid nitrogen or other extremely cool chemicals to freeze the affected tissues. […] Surgical excision of the lesions is an option that is not widely used due to fears of spread of the cancer to wound edges and surrounding tissues. […] Interferons are highly toxic molecules that may be tried in treatment of wide spread Kaposi’s sarcoma.
#1 Kaposi Sarcoma – Cancer Information – Oncology Hematology Care – OHC
https://ohcare.com/condition/kaposi-sarcoma/
Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy. […] Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. […] Immunotherapy or biologic therapy is a treatment that uses the patientâs immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodyâs natural defenses against cancer.
#1 Kaposi’s sarcoma | Macmillan Cancer Support
https://www.macmillan.org.uk/cancer-information-and-support/soft-tissue-sarcoma/kaposis-sarcoma
Local treatments help improve lesions you already have. But they do not stop new lesions developing. Sometimes other treatments are used to treat skin lesions, but this is not common. These may include: Surgery is sometimes used to remove small skin lesions; Cryotherapy, this treatment destroys the cancer cells by freezing them with liquid nitrogen; Chemotherapy into the skin lesion, sometimes chemotherapy drugs are injected into the skin lesions. This is called intralesional chemotherapy. It can shrink skin lesions and make them lighter in colour. Sometimes it can make them disappear completely. The side effects include swelling, pain and blistering around the injection area. This type of chemotherapy does not cause side effects in the rest of the body; Radiotherapy may be used to treat skin lesions. The dose given is usually low, so it does not cause many side effects. You may get skin changes in the treated area and feel tired. After radiotherapy finishes, side effects gradually improve.
#1 Kaposi Sarcoma Treatment | NY | Montefiore Einstein Comprehensive Cancer Center
https://montefioreeinstein.org/cancer/types/aids-related/kaposi-sarcoma-treatment
The following types of treatment are used to treat Kaposi sarcoma: HAART, Radiation therapy, Surgery, Cryosurgery, Chemotherapy, Immunotherapy. […] Treatment of epidemic Kaposi sarcoma combines treatment for Kaposi sarcoma with treatment for acquired immunodeficiency syndrome (AIDS). […] Highly active antiretroviral therapy (HAART) is a combination of several drugs used to lessen the damage to the immune system caused by human immunodeficiency virus (HIV) infection. […] Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] The following surgical procedures may be used for Kaposi sarcoma to treat small, surface lesions: Local excision, Electrodesiccation and curettage. […] Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
#1 Kaposiâs Sarcoma
https://www.texasoncology.com/types-of-cancer/sarcoma/kaposis-sarcoma
The following is a general overview of treatment for Kaposis sarcoma. Treatment may consist of surgery, chemotherapy, or a combination of these treatment techniques. Combining two or more of these treatment techniques has become an important approach for increasing a patients chance of cure and prolonging survival. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. […] There are currently no curative treatment options for patients with AIDS-related Kaposis sarcoma. These patients are initially treated with combination chemotherapy. Doxil (liposomal doxorubicin) may be the most active drug for the treatment of Kaposis sarcoma and has the advantage of causing less heart damage than standard doxorubicin. […] The topical Panretin gel (alitretinoin), comprised of a derivative of vitamin A as its active ingredient has been shown to be beneficial in one-third (35%) of patients treated with Panretin gel experienced a positive response to treatment compared to 18% who responded to a placebo.
#1 Kaposi’s Sarcoma | Conditions | UCSF Health
https://www.ucsfhealth.org/conditions/kaposis-sarcoma
A safe and fairly effective chemotherapy drug commonly used to treat Kaposi’s sarcoma is liposomal doxorubicin, known as Doxil. […] Radiation therapy uses high-dose X-rays or other high-energy rays to kill cancer cells and shrink tumors. […] Biological therapy tries to get the body to fight the cancer. It uses materials made by the body or made in a laboratory to boost, direct or restore the body’s natural defenses against disease.
#1 Kaposi’s sarcoma | Soft tissue sarcoma |Cancer Research UK
https://www.cancerresearchuk.org/about-cancer/soft-tissue-sarcoma/types/which-treatments-are-used-for-kaposis-sarcoma
You usually have chemotherapy if you have widespread KS lesions. Treatment at this stage is palliative. This means it is used to treat symptoms rather than offer a cure. You usually have 2 or more of these drugs: doxorubicin liposomal, daunorubicin liposomal, paclitaxel, vinorelbine, etoposide, gemcitabine. […] You might also have treatment as part of a clinical trial. Speak to your doctor if you’d like to know more about trials for Kaposi’s sarcoma.
#1 Therapeutic Perspectives in the Systemic Treatment of Kaposiâs Sarcoma
https://www.mdpi.com/2072-6694/14/3/484
Current therapeutic options include local and systemic treatments as chemotherapies and immunomodulatory drugs. […] Systemic chemotherapy for KS is, however, warranted in patients with advanced or rapidly progressive disease and is currently based on liposomal anthracyclines and taxanes. […] The anti-tumor activity and safety of taxanes have also been evaluated, mostly in patients with classic KS and AIDS-associated KS, with an overall response of the cutaneous lesions ranging from 40 to 65%. […] Other treatment options for subsequent lines of systemic chemotherapy, such as vinca alkaloids, bleomycin, and gemcitabine, can also be considered for AIDS- and non-AIDS-associated KS but are not recommended as first-line therapies. […] Inhibitors of the mTOR pathway as sirolimus (rapamycin) and temsirolimus have also been reported to have activity on KS.
#1 Kaposi Sarcoma – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK534839/
For local disease, sclerotherapy, intralesional vinca-alkaloids, bleomycin, interferon-alpha, topical alitretinoin, or imiquimod cream have all been used with success. […] Systemic chemotherapy approved for treatment of Kaposi sarcoma includes liposomal anthracyclins, paclitaxel, etoposide, vincristine, vinblastine, vinorelbine, bleomycin, or a combination of doxorubicin, bleomycin, and vincristine. […] Others have used interferon-alpha 2b with success. […] Thalidomide, VEGF inhibitors, tyrosine kinase inhibitors, and matrix metalloproteinases are currently under investigation as single agents to treat Kaposi sarcoma. […] Several studies are currently ongoing for new and novel treatment for Kaposi sarcoma.
#1 Kaposi Sarcoma Treatment (PDQ®): Treatment – Patient Information [NCI]
https://www.cham.org/HealthwiseArticle.aspx?id=ncicdr0000442381
Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue. […] Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. […] Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. […] Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. […] Treatment for Kaposi sarcoma may cause side effects. […] Treatment for single skin lesions may include the following: […] Treatment for skin lesions all over the body may include the following: […] Treatment for Kaposi sarcoma that affects lymph nodes or the gastrointestinal tract usually includes chemotherapy with or without radiation therapy. […] Treatment for epidemic Kaposi sarcoma may include the following:
#1 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
The choice of therapy beyond HAART must be individualized and depends on the extent of disease, the presence and nature of the symptoms, the rate of disease progression, and the overall therapeutic goals. […] Palliative systemic therapy is indicated for symptomatic or life-threatening visceral disease, rapidly progressive mucocutaneous disease with pain or ulceration, and symptomatic lymphedema. […] Interferon-alfa has clinical activity in Kaposi sarcoma that may be mediated by its antiangiogenic, antiviral, and immunomodulatory properties. […] Because of its highly vascular nature, Kaposi sarcoma has been thought of as a natural target for angiogenesis inhibition. […] A phase II study of thalidomide in 20 HIV-infected patients with Kaposi sarcoma resulted in a 40% response rate with median duration of response of 7 months.
#1 Kaposi’s Sarcoma: Staging and Treatment | OncoLink
https://www.oncolink.org/cancers/skin/kaposi-s-sarcoma/kaposi-s-sarcoma-staging-and-treatment
Chemotherapy is the use of anti-cancer medicines that go through your whole body. These medicines may be given through a vein (IV, intravenously) or by mouth. This is unlike when it is used as a local therapy and injected into the lesion. Examples of chemotherapy medications used for systemic treatment of KS are liposomal doxorubicin, liposomal daunorubicin, paclitaxel, nab-paclitaxel, gemcitabine, vinorelbine, bleomycin, vinblastine, vincristine, and etoposide. […] Immunotherapy is the use of medication to help your immune system fight cancer. Examples of immunotherapy medications used for KS are thalidomide, pomalidomide, and lenalidomide. […] You may be offered a clinical trial as part of your treatment plan.
#1 New Treatment Approved for Karposi Sarcoma | The AACR
https://www.aacr.org/patients-caregivers/progress-against-cancer/new-treatment-for-kaposi-sarcoma/
The U.S. Food and Drug Administration (FDA) has expanded the use of an immunomodulatory therapeutic called pomalidomide (Pomalyst) to include the treatment of adults who have Kaposi sarcoma. […] Pomalidomide is intended for use in treating adults who have AIDS-related Kaposi sarcoma after failure of HAART and Kaposi sarcoma in adult patients who are HIV-negative. […] The approval of pomalidomide for treating patients who have Kaposi sarcoma was based on results from the phase I/II Study 12-C-0047 clinical trial conducted by the National Cancer Institute. According to the FDA statement, 12 of the 18 HIV-positive patients had partial or complete tumor shrinkage, and the responses lasted a median of 12.5 months. Eight of the 10 HIV-negative patients had partial or complete tumor shrinkage, and the responses lasted a median of 10.5 months. […] The FDA approval was rendered on May 15, 2020.
#1 Current Approaches to Treating Kaposi Sarcomalogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/ac201106130000001/2011/06/13/current-approaches-treating-kaposi-sarcoma
Current Approaches to Treating Kaposi Sarcoma […] Here we present two case vignettes highlighting the clinical problem of Kaposi sarcoma. We then provide a primer on current treatment approaches. […] KS has become rare in the developed world since the advent of potent ART. However, as illustrated by the above recent cases from U.S. clinics, this disease still occurs and can be life-threatening in patients with advanced HIV-related immunosuppression. Clinicians should therefore remain familiar with treatment options. […] Restoration of the immune system is key to treatment of HHV-8âassociated disease. Therefore, treatment of AIDS-associated KS should always involve ART. […] Most patients with limited cutaneous disease show tumor regression with ART alone. For those with large or nonresponsive skin lesions, referral to an experienced dermatologist is recommended, as the potential treatment options are vast. They include local radiation, topical alitretinoin, liquid nitrogen, electron beam or laser therapy, photodynamic therapy, intralesional chemotherapy (most often with vinblastine), intralesional interferon-Î±, and intralesional human chorionic gonadotropin. […] In cases of severe disease, ART is sometimes given together with chemotherapy. Three chemotherapeutic agents are approved by the FDA for advanced KS: pegylated liposomal doxorubicin, liposomal daunorubicin, and paclitaxel. […] Because chemotherapy carries risk and some patients will respond to ART alone, chemotherapy is not recommended for all patients. Clinicians must weigh the risks and benefits with each individual patient, preferably in consultation with an oncologist. […] Several novel therapies are also being investigated for the treatment of KS. These include drugs that target vascular endothelial growth factors, tyrosine kinase, matrix metalloproteinases, and a number of molecular signaling pathways. […] In summary, KS remains an important clinical entity that causes a wide spectrum of disease in HIV-infected patients. Improving immune status with ART is the most critical element of treatment, but providers should also be aware of other available treatment modalities. In the setting of severe local or widely disseminated disease, clinicians should obtain oncology evaluation for possible systemic chemotherapy.
#1 Treating Kaposi Sarcoma | Kaposi Sarcoma Treatment Options | American Cancer Society
https://www.cancer.org/cancer/types/kaposi-sarcoma/treating.html
If youve been diagnosed with Kaposi sarcoma (KS), your treatment team will discuss your options with you. Its important to weigh the benefits of each treatment option against the possible risks and side effects. […] For patients with immune system problems, the most important treatment is keeping the immune system healthy and controlling any related infections. Other treatments are also used. Some patients might get 2 or more types of treatment together. […] Treatment for Kaposi sarcoma (KS) is more effective than it was a couple of decades ago. Doctors now better understand what causes KS and have much more experience treating KS than they did when this disease was quite rare. […] Choices about the best treatment options for each patient are based on the function of the immune system as well as the number, location, and size of the KS lesions. The patients general health is also a major factor. If the patient has other serious health problems, it can make some treatments a poor choice.
#1 Kaposi Sarcoma Treatment – NCI
https://www.cancer.gov/types/soft-tissue-sarcoma/patient/kaposi-treatment-pdq
Patients may want to think about taking part in a clinical trial. […] Treatment for single skin lesions may include Radiation therapy and Surgery. […] Treatment for skin lesions all over the body may include Radiation therapy, Chemotherapy, and Electrochemotherapy. […] Treatment for Kaposi sarcoma that affects lymph nodes or the gastrointestinal tract usually includes chemotherapy with or without radiation therapy. […] Treatment for epidemic Kaposi sarcoma may include HAART, Surgery, Cryosurgery, Radiation therapy, Chemotherapy using one or more anticancer drugs, Immunotherapy using interferon alfa or interleukin-12, and Targeted therapy using imatinib or bevacizumab.
#1 Kaposi sarcoma – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/kaposis-sarcoma/diagnosis-treatment/drc-20577331
A skin biopsy can confirm Kaposi sarcoma. […] There’s no cure for Kaposi sarcoma. But there are many treatment options that can help control it. […] Treatment for AIDS-related Kaposi sarcoma: Thanks to better antiviral medicines to treat AIDS and ways to prevent it, Kaposi sarcoma has become less common and less severe in people with AIDS. Taking antiviral medicines can lower the amount of the virus that causes HIV/AIDS and make the immune system stronger. This might be the only treatment needed for Kaposi sarcoma. […] Treatments for small skin lesions might include: Minor surgery, also called excision. Freezing treatment, called cryotherapy. Radiation therapy. An injection of the chemotherapy medicine vinblastine into lesions. Applying a medicine cream or gel to the skin. […] If Kaposi sarcoma causes many skin lesions, other treatments might be needed, such as: Radiation therapy. Radiation therapy uses powerful energy beams to kill cancer cells. This is a treatment option if there are many skin lesions, but not enough to need chemotherapy. Chemotherapy. Chemotherapy uses strong medicines to kill cancer cells. Chemotherapy might be an option when Kaposi sarcoma affects multiple parts of the body. For Kaposi sarcoma that’s getting worse quickly, chemotherapy might help.
#1 General Considerations in the Treatment of Kaposi Sarcoma | American Cancer Society
https://www.cancer.org/cancer/types/kaposi-sarcoma/treating/general-considerations.html
Chemotherapy may be added to HAART for patients with: Many skin or mouth lesions, Severe swelling from KS (lymphedema), Lung lesions causing shortness of breath, Lesions in the stomach and intestines that have caused anemia (low red blood cell count), weight loss, or other problems. […] For chemotherapy, paclitaxel or one of the liposomal anthracyclines is usually given. If those drugs do not work, other chemotherapy drugs can be tried. […] For people with AIDS-related KS whose HAART therapy no longer keeps the cancer under control, the immunomodulatory drug, pomalidomide, might be an option. It can also be used in people with KS who are HIV negative. […] Classic KS grows and spreads slowly, so lesions are more often treated with surgery, radiation therapy, or another local treatment like intralesional chemotherapy.
#1 Kaposi’s sarcoma | Macmillan Cancer Support
https://www.macmillan.org.uk/cancer-information-and-support/soft-tissue-sarcoma/kaposis-sarcoma
Treatments may include: Combination anti-retroviral therapy, if you have early-stage Kaposis and have not had treatment for HIV, you usually start combination anti-retroviral therapy (CART). It reduces the level of HIV in the body and improves your immunity. When treatment starts, Kaposis often gets better or disappears. But this can take several months to happen; Local treatments, if there are only a few skin lesions in a small area of your body, you can have treatments directly to the lesions (local treatment) using creams; Chemotherapy, you may be offered Chemotherapy that treats the whole body if Kaposi’s is more advanced, or you are already having HIV treatment when it is diagnosed. Chemotherapy is used if skin lesions are broken or bleeding (ulcerated). Or if your limbs are swollen or Kaposi’s is affecting the lungs, stomach, bowel or mouth.
#1 Therapeutic Perspectives in the Systemic Treatment of Kaposiâs Sarcoma
https://www.mdpi.com/2072-6694/14/3/484
New therapeutic targets are needed to efficiently treat patients with chemotherapy-refractory KS. Anti-angiogenic therapies constitute potential therapeutical targets due to the central role of angiogenesis in KS pathogenesis and could represent alternatives to chemotherapy. […] Immune checkpoints blockade also needs to be further evaluated in this context.
#1 Therapeutic Perspectives in the Systemic Treatment of Kaposiâs Sarcoma
https://www.mdpi.com/2072-6694/14/3/484
Therapeutic Perspectives in the Systemic Treatment of Kaposiâs Sarcoma […] Alternative systemic treatments are needed for patients who develop chemotherapy-refractory KS. Anti-angiogenic therapies represent attractive therapeutic targets in this context, due to the central role of angiogenesis in KS pathogenesis. […] Immune checkpoint blockade also represents an interesting alternative therapeutic approach through the restoration of immunity against HHV-8, the causative agent of KS, and improvement of tumor control. […] The therapeutic management is based on an individual approach taking into account the criteria of disease extension, the localized or disseminated character of the lesions, predictors of disease evolution, in particular the immunovirological status of the patients, and the patientâs comorbidities.
#1 Kaposiâs Sarcoma (KS): Types, Causes, Symptoms, Treatment
https://www.webmd.com/hiv-aids/aids-hiv-opportunistic-infections-kaposis-sarcoma
Chemotherapy can have side effects, including hair loss, vomiting, and fatigue. It can also lower the number of platelets and white blood cells and raise your chances of an infection. […] Another type of drug treatment, called biologic therapy, works by boosting your immune system. Your doctor may prescribe interferon alfa (Intron A) if your CD4 cell count (a type of white blood cell) is over 200 and you have a fairly healthy immune system. […] Clinical trials are testing targeted therapies such as monoclonal antibody therapy and tyrosine kinase inhibitors. These treatments are aimed at attacking the cancer and keeping it from growing without hurting healthy cells.
#1 Kaposi Sarcoma Treatment – Bakersfield Dermatologist
https://www.bakersfielddermatology.com/skincancer/kaposi-sarcoma/
The treatment of Kaposi sarcoma involves a multidisciplinary approach tailored to the type and stage of the disease. Treatment strategies aim to control cancer, alleviate symptoms, and improve overall well-being. […] The following are key approaches to treating Kaposi sarcoma: […] Enhancing Immune Function: Strengthening the immune system is a primary focus, especially in HIV-positive individuals. Antiretroviral therapy used to manage HIV can also help control Kaposi sarcoma. […] Local Therapies: For localized lesions, treatments like chemotherapy injections directly into the lesions, cryosurgery (freezing), excisions (surgical removal), phototherapy, or local radiation might be recommended. […] Chemotherapy: Chemotherapy may be necessary for cases where immune enhancement and local therapies arenât effective. Intravenous chemotherapy drugs are commonly used to target cancer cells.
#1 Kaposi Sarcoma Treatment – Bakersfield Dermatologist
https://www.bakersfielddermatology.com/skincancer/kaposi-sarcoma/
Immunotherapy: Immunotherapy, which activates the immune systemâs ability to fight cancer, is an emerging treatment option. Clinical trials are investigating its effectiveness in Kaposi sarcoma. […] Supportive Care: Managing symptoms and improving quality of life are integral. Pain management, wound care, and emotional support are essential components of care. […] Regular Follow-Up: Continuous monitoring is crucial for tracking the diseaseâs progress and detecting any recurrence or complications. […] Treatment decisions are made in consultation with a dermatologist, considering the patientâs health status, preferences, and specific circumstances. Individualized care plans ensure the most effective and suitable approach to managing Kaposi sarcoma.
#2 Kaposi Sarcoma Treatment (PDQÂ®) – NCI
https://www.cancer.gov/types/soft-tissue-sarcoma/hp/kaposi-treatment-pdq
Treatment options for localized skin disease include (options are equivalent): Radiation therapy. Surgery. Other options (cryo-laser, intralesional, and topical therapy). […] For solitary lesions or lesions of limited extent, modest doses of radiation applied with a limited margin provide excellent control of disease in the treated area. […] Surgical excision may benefit patients with small superficial lesions, but local recurrence is likely to occur. However, multiple small excisions can continue to be performed for good disease control. […] Treatment options for advanced skin disease include: Radiation therapy. Chemotherapy. Biological and targeted therapy. Immunotherapy. […] Because classic KS is such a rare disease in the United States, and is usually treated initially with radiation therapy, few patients have been treated with chemotherapy. Its use in classic KS is based on data extrapolated from treatment of AIDS-associated KS, and no randomized prospective trials have compared one agent with another in classic KS.
#2 Kaposi’s sarcoma | Macmillan Cancer Support
https://www.macmillan.org.uk/cancer-information-and-support/soft-tissue-sarcoma/kaposis-sarcoma
A team of specialists meets to discuss the best possible treatment plan for you. This is called a multidisciplinary team (MDT). […] Treatment of Kaposis sarcoma depends on different things, including: the type of Kaposis you have, the number and size of your lesions, where the lesions are, your general health. […] Treatment is usually given by doctors and nurses who specialise in treating the type of Kaposis you have. Or they may be experts in the area of the body where the Kaposis sarcoma is. […] You often have treatments directly to the lesions. This is called local treatment. The most common treatment for early skin lesions is a cream applied directly to the skin. This could be: an immunotherapy cream called imiquimod (Aldara), which is used to treat some skin cancers, is the most common treatment; a cream called alitretinoin gel 0.1%, which is is a type of retinoid cream (like vitamin A), is sometimes used.
#2 Kaposi’s sarcoma – Wikipedia
https://en.wikipedia.org/wiki/Kaposi%27s_sarcoma
Kaposi sarcoma is not curable, but it can often be treatable for many years. In KS associated with immunodeficiency or immunosuppression, treating the cause of the immune system dysfunction can slow or stop the progression of KS. In 40% or more of patients with AIDS-associated Kaposi sarcoma, the Kaposi lesions will shrink upon first starting highly active antiretroviral therapy (HAART). Therefore, HAART is considered the cornerstone of therapy in AIDS-associated Kaposi sarcoma. […] People with a few local lesions can often be treated with local measures such as radiation therapy or cryosurgery. Weak evidence suggests that antiretroviral therapy in combination with chemotherapy is more effective than either of those two therapies individually. Limited basic and clinical evidence suggest that topical beta-blockers, such as timolol, may induce regression of localized lesions in classic as well as HIV-associated Kaposi sarcoma.
#2 General Considerations in the Treatment of Kaposi Sarcoma | American Cancer Society
https://www.cancer.org/cancer/types/kaposi-sarcoma/treating/general-considerations.html
Different treatment options for Kaposi sarcoma (KS) were discussed in previous sections. Deciding which treatment to use depends on a number of factors, such as […] For someone with AIDS, the most important part of KS treatment is treating the HIV infection with anti-AIDS drug combinations. In many patients, KS lesions begin to get smaller as their immune function gets better. In some patients with AIDS, highly active antiretroviral therapy (HAART) may be the only treatment needed to treat the KS. HAART also helps AIDS patients live longer and feel better. Still, other treatments for KS may be needed to improve symptoms (like pain and swelling). […] A local treatment such as radiation therapy, cryosurgery, or a topical retinoid, may be used if a person has only a few skin lesions. KS tumors of the skin, mouth, or anus are sometimes treated with low-doses of radiation therapy. As a rule, doctors use radiation therapy to relieve symptoms or treat highly visible lesions. Sometimes radiation is given to patients who cant have chemotherapy because they are too weak or have poor liver function.
#2 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Iatrogenic or post-transplantation Kaposi sarcoma commonly responds to reduction or discontinuation of immunosuppression. In one study, tapering of immunosuppressive therapy alone led to complete or partial KS regression in 9 of 20 patients. […] Several retrospective and prospective studies have shown a benefit of switching from calcineurin inhibitors (eg, cyclosporine, tacrolimus) to a mammalian target of rapamycin (mTOR) inhibitor, specifically sirolimus. […] Chemotherapy is the preferred first-line therapy for refractory/relapsed limited cutaneous disease and advanced disease. It is indicated for symptomatic visceral or rapidly progressive mucocutaneous disease for which a rapid response is desirable. It is used in disseminated disease not amenable to local modalities. […] Current National Comprehensive Cancer Network (NCCN) guidelines recommend liposomal doxorubicin (or liposomal daunorubicin) or paclitaxel in the first-line setting. Sirolimus is the first-line recommendation following an organ transplant.
#2 General Considerations in the Treatment of Kaposi Sarcoma | American Cancer Society
https://www.cancer.org/cancer/types/kaposi-sarcoma/treating/general-considerations.html
Chemotherapy may be used for widespread skin lesions or for KS that is in the lymph nodes, the lungs, or the digestive tract. Liposomal anthracyclines or paclitaxel are the drugs most often used for chemotherapy. […] In people who have had organ transplants, KS lesions sometimes go away on their own if the drugs that suppress the immune system are changed or stopped. A drug called sirolimus may be used in place of another anti-rejection drug because it can often make KS lesions get smaller. […] Skin lesions can be treated with radiation therapy or another local treatment. Most doctors try to avoid giving chemotherapy in KS patients who have had organ transplants. But some patients may agree to take part in clinical trials of new drugs. […] Because endemic KS occurs in poor countries, treatment options are often limited. When available, the same treatments given for classic KS may be used.
#2 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Bevacizumab is a VEGF inhibitor that has been studied in AIDS-associated Kaposi sarcoma. […] Local therapy is best suited for patients who require palliation of locally advanced symptomatic disease (eg, radiation) or for those who have cosmetically unacceptable lesions. […] Radiation therapy is the most widely used and effective local therapy. […] Surgical excision may be of benefit for patients with small superficial lesions. […] Intralesional therapy with vinca alkaloids with low-dose vincristine or vinblastine as well as bleomycin has been used in a limited fashion primarily for the classic form of Kaposi sarcoma. […] Cryotherapy entails liquid nitrogen applied topically and may be useful for small facial lesions less than 1 cm in dimensions. […] Imiquimod, a topical immune response modulator, has shown safety and efficacy in patients with limited cutaneous classic or transplant-associated Kaposi sarcoma.
#2 Localized Radiotherapy for Classic Kaposiâs Sarcoma: An Analysis of Lesion Characteristics and Treatment Response
https://www.mdpi.com/2072-6694/16/18/3194
RT is widely recognized as the primary treatment for localized KS, with reported overall response rates of up to 100% and CR rates ranging from 30% to 90%. […] In our study, localized symptomatic lesions treated with RT showed excellent efficacy, achieving a 100% overall response rate and complete symptom resolution. […] Further research is needed to determine the optimal RT dose and fractionation.
#2 Kaposi Sarcoma – Cancer Information – Oncology Hematology Care – OHC
https://ohcare.com/condition/kaposi-sarcoma/
Kaposi sarcoma is a cancer that causes lesions (abnormal tissue) to grow in the skin, the mucous membranes lining the mouth, nose and throat, lymph nodes or other organs. […] There are four types of standard treatment. Your OHC doctor will help you determine the best care plan for you. […] Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] The following surgical procedures may be used for Kaposi sarcoma to treat small, surface lesions: Local excision: The cancer is cut from the skin along with a small amount of normal tissue around it. […] Electrodesiccation and curettage: The tumor is cut from the skin with a curette (a sharp, spoon-shaped tool). A needle-shaped electrode is then used to treat the area with an electric current that stops the bleeding and destroys cancer cells that remain around the edge of the wound. The process may be repeated one to three times during the surgery to remove all of the cancer.
#2 Kaposi’s sarcoma | Macmillan Cancer Support
https://www.macmillan.org.uk/cancer-information-and-support/soft-tissue-sarcoma/kaposis-sarcoma
Local treatments help improve lesions you already have. But they do not stop new lesions developing. Sometimes other treatments are used to treat skin lesions, but this is not common. These may include: Surgery is sometimes used to remove small skin lesions; Cryotherapy, this treatment destroys the cancer cells by freezing them with liquid nitrogen; Chemotherapy into the skin lesion, sometimes chemotherapy drugs are injected into the skin lesions. This is called intralesional chemotherapy. It can shrink skin lesions and make them lighter in colour. Sometimes it can make them disappear completely. The side effects include swelling, pain and blistering around the injection area. This type of chemotherapy does not cause side effects in the rest of the body; Radiotherapy may be used to treat skin lesions. The dose given is usually low, so it does not cause many side effects. You may get skin changes in the treated area and feel tired. After radiotherapy finishes, side effects gradually improve.
#2 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Currently, no treatment is available to eradicate HHV-8 infection. Therefore, there is no cure for Kaposi sarcoma (KS). Instead, the purpose of therapy in all forms of KS is directed at alleviating symptoms and slowing disease progression. Treatment decisions vary depending on KS form, presence of symptoms, and extent of disease. […] Lower extremity edema can be managed with compression stockings. Local therapies, including surgical resection, radiotherapy, cryotherapy, and intralesional chemotherapy, can be used to treat symptomatic or cosmetically unacceptable lesions. Systemic chemotherapy should be reserved for patients in whom local therapy fails or who have extensive disease. […] Therapy for epidemic Kaposi sarcoma centers on the use of highly active antiretroviral therapy (HAART), which has decreased the incidence and severity of this disease. Most good-risk patients show tumor regression with HAART alone. Local therapies can also be implemented for symptomatic or cosmetically disfiguring cutaneous lesions. The least invasive and toxic modality should be used due to high risk for infectious complications in this population. Poor-risk patients usually require a combination of chemotherapy with HAART. Treatment is typically continued until response plateau or unacceptable toxicity.
#2 Kaposi Sarcoma Treatment (PDQÂ®) – NCI
https://www.cancer.gov/types/soft-tissue-sarcoma/hp/kaposi-treatment-pdq
Small localized lesions of KS may be treated by electrodesiccation and curettage, cryotherapy, or by surgical excision. KS tumors are also generally very responsive to local radiation therapy, and excellent palliation has been obtained with doses at 20 Gy or slightly higher. […] The combination of antiretroviral therapy and liposomal doxorubicin resulted in a 5-year overall survival rate of 85% in 140 patients with T1 disease. […] The interferon alfas have also been widely studied and show a 40% objective response rate in patients with AIDS-associated KS. […] Pomalidomide is teratogenic, prescribed through a Risk Evaluation and Mitigation Strategy (REMS) program, and it should be given with aspirin to mitigate venous thromboembolism risk.
#2 Kaposi’s sarcoma | Soft tissue sarcoma |Cancer Research UK
https://www.cancerresearchuk.org/about-cancer/soft-tissue-sarcoma/types/which-treatments-are-used-for-kaposis-sarcoma
You usually have chemotherapy if you have widespread KS lesions. Treatment at this stage is palliative. This means it is used to treat symptoms rather than offer a cure. You usually have 2 or more of these drugs: doxorubicin liposomal, daunorubicin liposomal, paclitaxel, vinorelbine, etoposide, gemcitabine. […] You might also have treatment as part of a clinical trial. Speak to your doctor if you’d like to know more about trials for Kaposi’s sarcoma.
#2 Kaposi Sarcoma: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/2006845-overview
Immunomodulation with interferon-alfa has clinical activity in KS that may be mediated by its antiangiogenic, antiviral, and immunomodulatory properties. […] Combination therapy with regimens such as ABV (actinomycin D, bleomycin, vincristine) produces higher response rates than does single-agent therapy (such as doxorubicin), but time to progression and overall survival rates are similar. […] Several single cytotoxic agents have been approved by the Food and Drug Administration (FDA) for AIDS-related KS; they include the following: Liposomal doxorubicin (Doxil), Liposomal daunorubicin (DaunoXome), Paclitaxel (Taxol) or oral etoposide (VePesid). […] Liposomal technology has resulted in higher response rates with less cardiac toxicity and myelotoxicity for liposomal doxorubicin and liposomal daunorubicin.
#2 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
The choice of therapy beyond HAART must be individualized and depends on the extent of disease, the presence and nature of the symptoms, the rate of disease progression, and the overall therapeutic goals. […] Palliative systemic therapy is indicated for symptomatic or life-threatening visceral disease, rapidly progressive mucocutaneous disease with pain or ulceration, and symptomatic lymphedema. […] Interferon-alfa has clinical activity in Kaposi sarcoma that may be mediated by its antiangiogenic, antiviral, and immunomodulatory properties. […] Because of its highly vascular nature, Kaposi sarcoma has been thought of as a natural target for angiogenesis inhibition. […] A phase II study of thalidomide in 20 HIV-infected patients with Kaposi sarcoma resulted in a 40% response rate with median duration of response of 7 months.
#2 Therapeutic Perspectives in the Systemic Treatment of Kaposiâs Sarcoma
https://www.mdpi.com/2072-6694/14/3/484
Current therapeutic options include local and systemic treatments as chemotherapies and immunomodulatory drugs. […] Systemic chemotherapy for KS is, however, warranted in patients with advanced or rapidly progressive disease and is currently based on liposomal anthracyclines and taxanes. […] The anti-tumor activity and safety of taxanes have also been evaluated, mostly in patients with classic KS and AIDS-associated KS, with an overall response of the cutaneous lesions ranging from 40 to 65%. […] Other treatment options for subsequent lines of systemic chemotherapy, such as vinca alkaloids, bleomycin, and gemcitabine, can also be considered for AIDS- and non-AIDS-associated KS but are not recommended as first-line therapies. […] Inhibitors of the mTOR pathway as sirolimus (rapamycin) and temsirolimus have also been reported to have activity on KS.
#2 Kaposi Sarcoma Treatment – NCI
https://www.cancer.gov/types/soft-tissue-sarcoma/patient/kaposi-treatment-pdq
Patients may want to think about taking part in a clinical trial. […] Treatment for single skin lesions may include Radiation therapy and Surgery. […] Treatment for skin lesions all over the body may include Radiation therapy, Chemotherapy, and Electrochemotherapy. […] Treatment for Kaposi sarcoma that affects lymph nodes or the gastrointestinal tract usually includes chemotherapy with or without radiation therapy. […] Treatment for epidemic Kaposi sarcoma may include HAART, Surgery, Cryosurgery, Radiation therapy, Chemotherapy using one or more anticancer drugs, Immunotherapy using interferon alfa or interleukin-12, and Targeted therapy using imatinib or bevacizumab.
#3 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Iatrogenic or post-transplantation Kaposi sarcoma commonly responds to reduction or discontinuation of immunosuppression. In one study, tapering of immunosuppressive therapy alone led to complete or partial KS regression in 9 of 20 patients. […] Several retrospective and prospective studies have shown a benefit of switching from calcineurin inhibitors (eg, cyclosporine, tacrolimus) to a mammalian target of rapamycin (mTOR) inhibitor, specifically sirolimus. […] Chemotherapy is the preferred first-line therapy for refractory/relapsed limited cutaneous disease and advanced disease. It is indicated for symptomatic visceral or rapidly progressive mucocutaneous disease for which a rapid response is desirable. It is used in disseminated disease not amenable to local modalities. […] Current National Comprehensive Cancer Network (NCCN) guidelines recommend liposomal doxorubicin (or liposomal daunorubicin) or paclitaxel in the first-line setting. Sirolimus is the first-line recommendation following an organ transplant.
#3 Kaposi Sarcoma Treatment (PDQÂ®) – NCI
https://www.cancer.gov/types/soft-tissue-sarcoma/hp/kaposi-treatment-pdq
Treatment options for localized skin disease include (options are equivalent): Radiation therapy. Surgery. Other options (cryo-laser, intralesional, and topical therapy). […] For solitary lesions or lesions of limited extent, modest doses of radiation applied with a limited margin provide excellent control of disease in the treated area. […] Surgical excision may benefit patients with small superficial lesions, but local recurrence is likely to occur. However, multiple small excisions can continue to be performed for good disease control. […] Treatment options for advanced skin disease include: Radiation therapy. Chemotherapy. Biological and targeted therapy. Immunotherapy. […] Because classic KS is such a rare disease in the United States, and is usually treated initially with radiation therapy, few patients have been treated with chemotherapy. Its use in classic KS is based on data extrapolated from treatment of AIDS-associated KS, and no randomized prospective trials have compared one agent with another in classic KS.
#3 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Bevacizumab is a VEGF inhibitor that has been studied in AIDS-associated Kaposi sarcoma. […] Local therapy is best suited for patients who require palliation of locally advanced symptomatic disease (eg, radiation) or for those who have cosmetically unacceptable lesions. […] Radiation therapy is the most widely used and effective local therapy. […] Surgical excision may be of benefit for patients with small superficial lesions. […] Intralesional therapy with vinca alkaloids with low-dose vincristine or vinblastine as well as bleomycin has been used in a limited fashion primarily for the classic form of Kaposi sarcoma. […] Cryotherapy entails liquid nitrogen applied topically and may be useful for small facial lesions less than 1 cm in dimensions. […] Imiquimod, a topical immune response modulator, has shown safety and efficacy in patients with limited cutaneous classic or transplant-associated Kaposi sarcoma.
#3 Kaposi Sarcoma Treatment (PDQÂ®) – NCI
https://www.cancer.gov/types/soft-tissue-sarcoma/hp/kaposi-treatment-pdq
Small localized lesions of KS may be treated by electrodesiccation and curettage, cryotherapy, or by surgical excision. KS tumors are also generally very responsive to local radiation therapy, and excellent palliation has been obtained with doses at 20 Gy or slightly higher. […] The combination of antiretroviral therapy and liposomal doxorubicin resulted in a 5-year overall survival rate of 85% in 140 patients with T1 disease. […] The interferon alfas have also been widely studied and show a 40% objective response rate in patients with AIDS-associated KS. […] Pomalidomide is teratogenic, prescribed through a Risk Evaluation and Mitigation Strategy (REMS) program, and it should be given with aspirin to mitigate venous thromboembolism risk.
#3 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
The choice of therapy beyond HAART must be individualized and depends on the extent of disease, the presence and nature of the symptoms, the rate of disease progression, and the overall therapeutic goals. […] Palliative systemic therapy is indicated for symptomatic or life-threatening visceral disease, rapidly progressive mucocutaneous disease with pain or ulceration, and symptomatic lymphedema. […] Interferon-alfa has clinical activity in Kaposi sarcoma that may be mediated by its antiangiogenic, antiviral, and immunomodulatory properties. […] Because of its highly vascular nature, Kaposi sarcoma has been thought of as a natural target for angiogenesis inhibition. […] A phase II study of thalidomide in 20 HIV-infected patients with Kaposi sarcoma resulted in a 40% response rate with median duration of response of 7 months.
#3 Kaposi sarcoma
https://dermnetnz.org/topics/kaposi-sarcoma
HAART plus chemotherapy is found to be more effective than HAART alone or chemotherapy alone in treating Kaposi sarcoma. […] Iatrogenic Kaposi sarcoma may improve or clear if it is possible to stop the immune suppressive medication. […] The choice of a more specific treatment depends mainly on the extent of the disease. […] Small, localised lesions are generally only treated if they are painful or they are causing cosmetic problems. […] Treatments include: Cryotherapy with liquid nitrogen, Radiotherapy. This is most useful for classic Kaposi sarcoma and is less effective for HIV-associated disease, Surgical excision of individual nodules, Laser therapy using pulsed dye laser or pulsed carbon dioxide laser, Injection with anti-cancer drugs such as vinblastine, Topical application of alitretinoin gel (Panretin). This drug is not yet available in New Zealand, Electrochemotherapy, a new treatment that uses electrical impulses to enhance effectiveness of bleomycin or cisplatin injected into tumours.
#3 Kaposi Sarcoma Treatment – NCI
https://www.cancer.gov/types/soft-tissue-sarcoma/patient/kaposi-treatment-pdq
Patients may want to think about taking part in a clinical trial. […] Treatment for single skin lesions may include Radiation therapy and Surgery. […] Treatment for skin lesions all over the body may include Radiation therapy, Chemotherapy, and Electrochemotherapy. […] Treatment for Kaposi sarcoma that affects lymph nodes or the gastrointestinal tract usually includes chemotherapy with or without radiation therapy. […] Treatment for epidemic Kaposi sarcoma may include HAART, Surgery, Cryosurgery, Radiation therapy, Chemotherapy using one or more anticancer drugs, Immunotherapy using interferon alfa or interleukin-12, and Targeted therapy using imatinib or bevacizumab.
#4 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Iatrogenic or post-transplantation Kaposi sarcoma commonly responds to reduction or discontinuation of immunosuppression. In one study, tapering of immunosuppressive therapy alone led to complete or partial KS regression in 9 of 20 patients. […] Several retrospective and prospective studies have shown a benefit of switching from calcineurin inhibitors (eg, cyclosporine, tacrolimus) to a mammalian target of rapamycin (mTOR) inhibitor, specifically sirolimus. […] Chemotherapy is the preferred first-line therapy for refractory/relapsed limited cutaneous disease and advanced disease. It is indicated for symptomatic visceral or rapidly progressive mucocutaneous disease for which a rapid response is desirable. It is used in disseminated disease not amenable to local modalities. […] Current National Comprehensive Cancer Network (NCCN) guidelines recommend liposomal doxorubicin (or liposomal daunorubicin) or paclitaxel in the first-line setting. Sirolimus is the first-line recommendation following an organ transplant.
#4 Kaposi Sarcoma Treatment (PDQÂ®) – NCI
https://www.cancer.gov/types/soft-tissue-sarcoma/hp/kaposi-treatment-pdq
Treatment options for localized skin disease include (options are equivalent): Radiation therapy. Surgery. Other options (cryo-laser, intralesional, and topical therapy). […] For solitary lesions or lesions of limited extent, modest doses of radiation applied with a limited margin provide excellent control of disease in the treated area. […] Surgical excision may benefit patients with small superficial lesions, but local recurrence is likely to occur. However, multiple small excisions can continue to be performed for good disease control. […] Treatment options for advanced skin disease include: Radiation therapy. Chemotherapy. Biological and targeted therapy. Immunotherapy. […] Because classic KS is such a rare disease in the United States, and is usually treated initially with radiation therapy, few patients have been treated with chemotherapy. Its use in classic KS is based on data extrapolated from treatment of AIDS-associated KS, and no randomized prospective trials have compared one agent with another in classic KS.
#4 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Bevacizumab is a VEGF inhibitor that has been studied in AIDS-associated Kaposi sarcoma. […] Local therapy is best suited for patients who require palliation of locally advanced symptomatic disease (eg, radiation) or for those who have cosmetically unacceptable lesions. […] Radiation therapy is the most widely used and effective local therapy. […] Surgical excision may be of benefit for patients with small superficial lesions. […] Intralesional therapy with vinca alkaloids with low-dose vincristine or vinblastine as well as bleomycin has been used in a limited fashion primarily for the classic form of Kaposi sarcoma. […] Cryotherapy entails liquid nitrogen applied topically and may be useful for small facial lesions less than 1 cm in dimensions. […] Imiquimod, a topical immune response modulator, has shown safety and efficacy in patients with limited cutaneous classic or transplant-associated Kaposi sarcoma.
#4 Kaposi Sarcoma Treatment (PDQÂ®) – NCI
https://www.cancer.gov/types/soft-tissue-sarcoma/hp/kaposi-treatment-pdq
Small localized lesions of KS may be treated by electrodesiccation and curettage, cryotherapy, or by surgical excision. KS tumors are also generally very responsive to local radiation therapy, and excellent palliation has been obtained with doses at 20 Gy or slightly higher. […] The combination of antiretroviral therapy and liposomal doxorubicin resulted in a 5-year overall survival rate of 85% in 140 patients with T1 disease. […] The interferon alfas have also been widely studied and show a 40% objective response rate in patients with AIDS-associated KS. […] Pomalidomide is teratogenic, prescribed through a Risk Evaluation and Mitigation Strategy (REMS) program, and it should be given with aspirin to mitigate venous thromboembolism risk.
#4 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
The choice of therapy beyond HAART must be individualized and depends on the extent of disease, the presence and nature of the symptoms, the rate of disease progression, and the overall therapeutic goals. […] Palliative systemic therapy is indicated for symptomatic or life-threatening visceral disease, rapidly progressive mucocutaneous disease with pain or ulceration, and symptomatic lymphedema. […] Interferon-alfa has clinical activity in Kaposi sarcoma that may be mediated by its antiangiogenic, antiviral, and immunomodulatory properties. […] Because of its highly vascular nature, Kaposi sarcoma has been thought of as a natural target for angiogenesis inhibition. […] A phase II study of thalidomide in 20 HIV-infected patients with Kaposi sarcoma resulted in a 40% response rate with median duration of response of 7 months.
#5 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Bevacizumab is a VEGF inhibitor that has been studied in AIDS-associated Kaposi sarcoma. […] Local therapy is best suited for patients who require palliation of locally advanced symptomatic disease (eg, radiation) or for those who have cosmetically unacceptable lesions. […] Radiation therapy is the most widely used and effective local therapy. […] Surgical excision may be of benefit for patients with small superficial lesions. […] Intralesional therapy with vinca alkaloids with low-dose vincristine or vinblastine as well as bleomycin has been used in a limited fashion primarily for the classic form of Kaposi sarcoma. […] Cryotherapy entails liquid nitrogen applied topically and may be useful for small facial lesions less than 1 cm in dimensions. […] Imiquimod, a topical immune response modulator, has shown safety and efficacy in patients with limited cutaneous classic or transplant-associated Kaposi sarcoma.
#5 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Iatrogenic or post-transplantation Kaposi sarcoma commonly responds to reduction or discontinuation of immunosuppression. In one study, tapering of immunosuppressive therapy alone led to complete or partial KS regression in 9 of 20 patients. […] Several retrospective and prospective studies have shown a benefit of switching from calcineurin inhibitors (eg, cyclosporine, tacrolimus) to a mammalian target of rapamycin (mTOR) inhibitor, specifically sirolimus. […] Chemotherapy is the preferred first-line therapy for refractory/relapsed limited cutaneous disease and advanced disease. It is indicated for symptomatic visceral or rapidly progressive mucocutaneous disease for which a rapid response is desirable. It is used in disseminated disease not amenable to local modalities. […] Current National Comprehensive Cancer Network (NCCN) guidelines recommend liposomal doxorubicin (or liposomal daunorubicin) or paclitaxel in the first-line setting. Sirolimus is the first-line recommendation following an organ transplant.
#6 Kaposi Sarcoma Treatment & Management: Approach Considerations, Medical Care, Local Therapy
https://emedicine.medscape.com/article/279734-treatment
Bevacizumab is a VEGF inhibitor that has been studied in AIDS-associated Kaposi sarcoma. […] Local therapy is best suited for patients who require palliation of locally advanced symptomatic disease (eg, radiation) or for those who have cosmetically unacceptable lesions. […] Radiation therapy is the most widely used and effective local therapy. […] Surgical excision may be of benefit for patients with small superficial lesions. […] Intralesional therapy with vinca alkaloids with low-dose vincristine or vinblastine as well as bleomycin has been used in a limited fashion primarily for the classic form of Kaposi sarcoma. […] Cryotherapy entails liquid nitrogen applied topically and may be useful for small facial lesions less than 1 cm in dimensions. […] Imiquimod, a topical immune response modulator, has shown safety and efficacy in patients with limited cutaneous classic or transplant-associated Kaposi sarcoma.