Sandbox: Kaposi 2

Kaposi's sarcoma is not curable, in the usual sense of the word, but it can often be effectively palliated for many years and this is the aim of treatment. 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's sarcoma, the Kaposi lesions will shrink upon first starting highly active antiretroviral therapy (HAART). However, in a certain percentage of such patients, Kaposi's sarcoma may again grow after a number of years on HAART, especially if HIV is not completely suppressed. Patients with a few local lesions can often be treated with local measures such as radiation therapy or cryotherapy. Surgery is generally not recommended as Kaposi's sarcoma can appear in wound edges.

Therapies

• Local therapy:
  • Topical treatment: This is the treatment to put medicine directly on the lesions.
  • Cryosurgery: During this procedure, the doctor use a probe cooled with liquid nitrogen to freeze the lesions.
  • Intralesional chemotherapy: In this procedure, the chemotherapy drug is injected directly into the Kaposi's sarcoma lesions.

• Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.

• Chemotherapy: More widespread disease, or disease affecting internal organs, is generally treated with systemic therapy with interferon alpha, liposomal anthracyclines (such as Doxil) or paclitaxel.

• Biologic therapy: This treatment uses chemicals such as interferon alpha to help the immune system attack cancer cells.

Antimicrobial Regimen

• Human herpesvirus 8 (KSHV)

• 1. Mild to moderate Kaposi sarcoma

• Preferred regimen: initiate or optimize ART

• 2. Advanced Kaposi sarcoma (ACTG Stage T1, including disseminated cutaneous or visceral Kaposi sarcoma)

• Preferred regimen: chemotherapy (per oncology consult) AND ART

• 3. Primary effusion lymphoma

• Preferred regimen: chemotherapy (per oncology consult) AND ART
• Note: Valganciclovir PO or Ganciclovir IV can be used as adjunctive therapy.

• 4. Multicentric Castleman's disease

• Preferred regimen (1): Valganciclovir 900 mg PO bid for 3 weeks
• Preferred regimen (2): Ganciclovir 5 mg/kg IV q12h for 3 weeks
• Preferred regimen (3): Valganciclovir 900 mg PO BID AND Zidovudine 600 mg PO q6h for 7–21 days
• Alternative regimen: Rituximab 375 mg/m2 given weekly for 4–8 weeks (may be an alternative to or used adjunctively with antiviral therapy)