Sandbox: Kaposi 2: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
 
(2 intermediate revisions by the same user not shown)
Line 1: Line 1:
* The optimal therapy for Kaposi's sarcoma depends on multiple factors which include:
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.
:* The anatomical location of the tumor
:* The specific variant of Kaposi's sarcoma
:* The rate of distribution and progression of Kaposi's sarcoma lesions
:* The patients clinical presentation
:* The efficacy and potential side effects of therapy
:* The presence or absence of HIV infection
:* The degree of immune suppression,
:* The presence of other comorbidities
:* The degree of host immune competence
:* The preference and prognosis of the patients


* Management strategies varies depending on the specific variant of Kaposi's sarcoma such as:
===Therapies===
:* Classic Kaposi's sarcoma managemenet may range from no treatment to either radiotherapy, local interventions, or surgical excision.  
*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.


Therapy for KS aims to palliate symptoms, reduce tumor-associated edema, and improve esthetics and function.
*Chemotherapy: More widespread disease, or disease affecting internal organs, is generally treated with systemic therapy with [[interferon]] alpha, [[liposomal]] [[anthracycline]]s (such as Doxil) or [[paclitaxel]].
Therapeutic approaches for classic KS range from no treatment to surgical excision, local interventions, and radiotherapy.
 
Management of iatrogenic KS often involves reduction or elimination of immunosuppressive therapy with or without local measures
*Biologic therapy: This treatment uses chemicals such as interferon alpha to help the immune system attack cancer cells.
Endemic KS is frequently responsive to systemic chemotherapy
 
Management of epidemic KS, in contrast, is not aimed at a cure but palliation and control of KS progression with HAART is considered an essential component of this process.
===Antimicrobial Regimen===
 
* '''Human herpesvirus 8 (KSHV)'''
:* 1. '''Mild to moderate Kaposi sarcoma'''<ref>{{ cite web | title = Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url = https://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultOITablesOnly.pdf }}</ref>
::* 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)

Latest revision as of 19:03, 21 January 2016

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.
  • 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[1]
  • 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)
  1. ↑ "Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents" (PDF).
Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox:_Kaposi_2&oldid=1204844"