Summary
Kaposi's sarcoma (KS) is still one of the most common malignancies in patients with human immunodeficiency virus (HIV) infection. Large randomized clinical trials have shown a protective effect of combination antiretroviral therapy (cART) against the development of KS, even in patients with a relatively preserved immune system. In patients with sufficient cART, KS has become a rarity. In most patients with HIV-associated KS who initiate cART, the KS lesions stabilize with decreasing HIV plasma viremia and immune reconstitution, or even resolve completely without any specific treatment. In patients with advanced or rapidly progressive disease, especially in the setting of an immune reconstitution syndrome, cART should be combined with cytotoxic chemotherapies. With regard to the KS pathogenesis, several new therapies have been suggested, such as antiviral agents, cytokines, and inhibitors of angiogenesis.
References
1.
Simard EP, Pfeiffer RM, Engels EA: Cumulative incidence of cancer among individuals with acquired immunodeficiency syndrome in the United States. Cancer 2011;117:1089-1096.
2.
Mocroft A, Kirk O, Clumeck N, Gargalianos-Kakolyris P, Trocha H, Chentsova N, Antunes F, Stellbrink HJ, Phillips AN, Lundgren JD: The changing pattern of Kaposi sarcoma in patients with HIV, 1994-2003: the EuroSIDA Study. Cancer 2004;100:2644-2654.
3.
Letang E, Lewis JJ, Bower M, Mosam A, Borok M, Campbell TB, Naniche D, Newsom-Davis T, Shaik F, Fiorillo S, Miro JM, Schellenberg D, Easterbrook PJ: Immune reconstitution inflammatory syndrome associated with Kaposi sarcoma: higher incidence and mortality in Africa than in the UK. AIDS 2013;27:1603-1613.
4.
Cancian L, Hansen A, Boshoff C: Cellular origin of Kaposi's sarcoma and Kaposi's sarcoma-associated herpesvirus-induced cell reprogramming. Trends Cell Biol 2013;23:421-432.
5.
Chang Y, Cesarman E, Pessin MS, Lee F, Culpepper J, Knowles DM, Moore PS: Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi's sarcoma. Science 1994;266:1865-1869.
6.
Minhas V, Wood C: Epidemiology and transmission of Kaposi's sarcoma-associated herpesvirus. Viruses 2014;6:4178-4194.
7.
Krown SE, Lee JY, Dittmer DP; AIDS Malignancy Consortium: More on HIV-associated Kaposi's sarcoma. N Engl J Med 2008;358:535-536.
8.
Haq IU, Dalla Pria A, Papanastasopoulos P, Stegmann K, Bradshaw D, Nelson M, Bower M: The clinical application of plasma Kaposi sarcoma herpesvirus viral load as a tumour biomarker: results from 704 patients. HIV Med 2016;17:56-61.
9.
Bower M, Dalla Pria A, Coyle C, Andrews E, Tittle V, Dhoot S, Nelson M: Prospective stage-stratified approach to AIDS-related Kaposi's sarcoma. J Clin Oncol 2014;32:409-414.
10.
Meyer L, Stoehr A, Horst HA, Plettenberg A, Lorenzen T, Schewe K, Sabranski M, Hoffmann C: Clinical characteristics of HIV-associated Kaposi's sarcoma in the era of combination antiretroviral therapy. Oncol Res Treat 2016;39(suppl 3):175.
11.
Borges ÁH, Neuhaus J, Babiker AG, Henry K, Jain MK, Palfreeman A, Mugyenyi P, Domingo P, Hoffmann C, Read TR, Pujari S, Meulbroek M, Johnson M, Wilkin T, Mitsuyasu R; INSIGHT START Study Group: Immediate antiretroviral therapy reduces risk of infection-related cancer during early HIV infection. Clin Infect Dis 2016;63:1668-1676.
12.
Silverberg MJ, Neuhaus J, Bower M, Gey D, Hatzakis A, Henry K, Hidalgo J, Lourtau L, Neaton JD, Tambussi G, Abrams DI: Risk of cancers during interrupted antiretroviral therapy in the SMART study. AIDS 2007;21:1957-1963.
13.
Cancer Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord: Changing incidence and risk factors for Kaposi sarcoma by time since starting antiretroviral therapy: collaborative analysis of 21 European cohort studies. Clin Infect Dis 2016;63:1373-1379.
14.
Sgadari C, Barillari G, Toschi E, Carlei D, Bacigalupo I, Baccarini S, Palladino C, Leone P, Bugarini R, Malavasi L, Cafaro A, Falchi M, Valdembri D, Rezza G, Bussolino F, Monini P, Ensoli B: HIV protease inhibitors are potent anti-angiogenic molecules and promote regression of Kaposi sarcoma. Nat Med 2002;8:225-232.
15.
Gantt S, Cattamanchi A, Krantz E, Magaret A, Selke S, Kuntz SR, Huang ML, Corey L, Wald A, Casper C: Reduced human herpesvirus-8 oropharyngeal shedding associated with protease inhibitor-based antiretroviral therapy. J Clin Virol 2014;60:127-132.
16.
Kowalkowski MA, Kramer JR, Richardson PR, Suteria I, Chiao EY: Use of boosted protease inhibitors reduces Kaposi sarcoma incidence among male veterans with HIV infection. Clin Infect Dis 2015;60:1405-1414.
17.
Grabar S, Abraham B, Mahamat A, Del Giudice P, Rosenthal E, Costagliola D: Differential impact of combination antiretroviral therapy in preventing Kaposi's sarcoma with and without visceral involvement. J Clin Oncol 2006;24:3408-3414.
18.
Martin J, Laker-Oketta M, Walusansa V, Orem J, Bennett J, Mocello A, Maurer T, Hunt P, Kambugu A, Mbidde E: Randomized trial of protease inhibitor-based antiretroviral therapy for Kaposi sarcoma in Africa. Boston, Conference on Retroviruses and Opportunistic Infections 2014;abstr 710.
19.
Di Trolio R, Di Lorenzo G, Delfino M, De Placido S: Role of pegylated liposomal doxorubicin (PLD) in systemic Kaposi's sarcoma: a systematic review. Int J Immunopathol Pharmacol 2006;19:253-263.
20.
Lichterfeld M, Qurishi N, Hoffmann C, Hochdorfer B, Brockmeyer NH, Arasteh K, Mauss S, Rockstroh JK; German Clinical AIDS Working Group (KAAD): Treatment of HIV-1-associated Kaposi's sarcoma with pegylated liposomal doxorubicin and HAART simultaneously induces effective tumor remission and CD4+ T cell recovery. Infection 2005;33:140-147.
21.
Cooley T, Henry D, Tonda M, Sun S, O'Connell M, Rackoff W: A randomized, double-blind study of pegylated liposomal doxorubicin for the treatment of AIDS-related Kaposi's sarcoma. Oncologist 2007;12:114-123.
22.
Cianfrocca M, Lee S, Von Roenn J, Tulpule A, Dezube BJ, Aboulafia DM, Ambinder RF, Lee JY, Krown SE, Sparano JA: Randomized trial of paclitaxel versus pegylated liposomal doxorubicin for advanced human immunodeficiency virus-associated Kaposi sarcoma: evidence of symptom palliation from chemotherapy. Cancer 2010;116:3969-3977.
23.
Osoba D, Northfeld DW, Budd DW, Himmelberger D: Effect of treatment on health-related quality of life in acquired immunodeficieny syndrome (AIDS)-related Kaposi's sarcoma: a randomized trial of pegylated-liposomal doxorubicin versus doxorubicin, bleomycin and vincristine. Cancer Invest 2001;19:573-580.
24.
Gbabe OF, Okwundu CI, Dedicoat M, Freeman EE: Treatment of severe or progressive Kaposi's sarcoma in HIV-infected adults. Cochrane Database Syst Rev 2014;(9):CD003256.
25.
Krown SE, Li P, Von Roenn JH, Paredes J, Huang J, Testa MA: Efficacy of low-dose interferon with antiretroviral therapy in Kaposi's sarcoma: a randomized phase II AIDS clinical trials group study. J Interferon Cytokine Res 2002;22:295-303.
26.
Rokx C, van der Ende ME, Verbon A, Rijnders BJ: Peginterferon alfa-2a for AIDS-associated Kaposi sarcoma: experience with 10 patients. Clin Infect Dis 2013;57:1497-1499.
27.
Célestin Schartz NE, Chevret S, Paz C, Kerob D, Verola O, Morel P, Lebbé C: Imiquimod 5% cream for treatment of HIV-negative Kaposi's sarcoma skin lesions: a phase I to II, open-label trial in 17 patients. J Am Acad Dermatol 2008;58:585-591.
28.
Brambilla L, Tourlaki A, Ferrucci S, Brambati M, Boneschi V: Treatment of classic Kaposi's sarcoma-associated lymphedema with elastic stockings. J Dermatol 2006;33:451-456.
29.
Donato V, Guarnaccia R, Dognini J, de Pascalis G, Caruso C, Bellagamba R, Morrone A: Radiation therapy in the treatment of HIV-related Kaposi's sarcoma. Anticancer Res 2013;33:2153-2157.
30.
Casper C, Krantz EM, Corey L, Kuntz SR, Wang J, Selke S, Hamilton S, Huang ML, Wald A: Valganciclovir for suppression of human herpesvirus-8 replication: a randomized, double-blind, placebo-controlled, crossover trial. J Infect Dis 2008;198:23-30.
31.
Krown SE, Dittmer DP, Cesarman E: Pilot study of oral valganciclovir therapy in patients with classic Kaposi sarcoma. J Infect Dis 2011;203:1082-1086.
32.
Martinez V, Tateo M, Castilla MA, Melica G, Kirstetter M, Boué F: Lenalidomide in treating AIDS-related Kaposi's sarcoma. AIDS 2011;25:878-880.
33.
Steff M, Joly V, Di Lucca J, Feldman J, Burg S, Sarda-Mantel L, Peytavin G, Marinho E, Crickx B, Raymond E, Lariven S, Maubec E: Clinical activity of lenalidomide in visceral human immunodeficiency virus-related Kaposi sarcoma. JAMA Dermatol 2013;149:1319-1322.
34.
Stallone G, Schena A, Infante B, Di Paolo S, Loverre A, Maggio G, Ranieri E, Gesualdo L, Schena FP, Grandaliano G: Sirolimus for Kaposi's sarcoma in renal-transplant recipients. N Engl J Med 2005;352:1317-1323.
35.
Uldrick TS, Wyvill KM, Kumar P, O'Mahony D, Bernstein W, Aleman K, Polizzotto MN, Steinberg SM, Pittaluga S, Marshall V, Whitby D, Little RF, Yarchoan R: Phase II study of bevacizumab in patients with HIV-associated Kaposi's sarcoma receiving antiretroviral therapy. J Clin Oncol 2012;30:1476-1483.
36.
Koon HB, Krown SE, Lee JY, Honda K, Rapisuwon S, Wang Z, Aboulafia D, Reid EG, Rudek MA, Dezube BJ, Noy A: Phase II trial of imatinib in AIDS-associated Kaposi's sarcoma: AIDS Malignancy Consortium Protocol 042. J Clin Oncol 2014;32:402-408.
37.
Koon HB, Fingleton B, Lee JY, Geyer JT, Cesarman E, Parise RA, Egorin MJ, Dezube BJ, Aboulafia D, Krown SE: Phase II AIDS Malignancy Consortium trial of topical halofuginone in AIDS-related Kaposi sarcoma. J AIDS 2011;56:64-68.
© 2017 S. Karger GmbH, Freiburg
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
