General Considerations in the Treatment of Kaposi Sarcoma

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

• The type of KS (which helps predict how fast the disease may grow and spread)
• The number and location of the KS lesions
• What kinds of problems the KS is causing
• The person’s overall health

These factors need to be considered because certain treatments, such as chemotherapy, can have serious side effects. Someone who is weak or sick from other problems may not be able to tolerate chemotherapy. In a case like this, the chemo may do more harm than good.

AIDS-related Kaposi sarcoma

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 can’t have chemotherapy because they are too weak or have poor liver function.

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 (see the section about chemotherapy treatment for KS).

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 Kaposi sarcoma

Classic KSgrows and spreads slowly, so lesions are more often treated with surgery, radiation therapy, or another local treatment like intralesional chemotherapy.

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.

Transplant-related Kaposi sarcoma

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.

Endemic Kaposi sarcoma

Because endemic KS occurs in poor countries, treatment options are often limited. When available, the same treatments given for classic KS may be used.