Kaposi's sarcoma medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Kaposi's sarcoma}} | {{Kaposi's sarcoma}} | ||
{{CMG}} {{AE}} {{HL}} | {{CMG}} {{shyam}} {{AE}} {{HL}} | ||
==Overview== | ==Overview== | ||
The optimal therapy for Kaposi's sarcoma depends on multiple factors. Management strategies varies depending on the specific variant of Kaposi's sarcoma. Classic Kaposi's sarcoma management may range from no treatment to either [[radiotherapy]], local therapeutic interventions, or surgical excision. Iatrogenic Kaposi's sarcoma management focuses on modifying [[immunosuppressive therapy]] in addition to local therapeutic interventions. Endemic Kaposi's sarcoma is primarily | The optimal therapy for Kaposi's sarcoma depends on multiple factors. Management strategies varies depending on the specific variant of Kaposi's sarcoma. Classic Kaposi's sarcoma management may range from no treatment to either [[radiotherapy]], local [[therapeutic]] interventions, or [[surgical]] [[excision]]. [[Iatrogenic]] Kaposi's sarcoma management focuses on modifying [[immunosuppressive therapy]] in addition to local [[therapeutic]] interventions. [[Endemic]] Kaposi's sarcoma is primarily managed by systemic [[chemotherapy]]. However, there is no curative treatment for [[epidemic]] Kaposi's sarcoma; the mainstay management for such patients is [[Highly active antiretroviral therapy|HAART therapy]] which aims for the control of Kaposi's sarcoma progression. | ||
==Medical Therapy== | ==Medical Therapy== | ||
* The optimal therapy for Kaposi's sarcoma depends on multiple factors which include:<ref name="pmid22677687">{{cite journal| author=Fatahzadeh M| title=Kaposi sarcoma: review and medical management update. | journal=Oral Surg Oral Med Oral Pathol Oral Radiol | year= 2012 | volume= 113 | issue= 1 | pages= 2-16 | pmid=22677687 | doi=10.1016/j.tripleo.2011.05.011 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22677687 }} </ref><ref name="pmid24585567">{{cite journal| author=Masur H, Brooks JT, Benson CA, Holmes KK, Pau AK, Kaplan JE et al.| title=Prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Updated Guidelines from the Centers for Disease Control and Prevention, National Institutes of Health, and HIV Medicine Association of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2014 | volume= 58 | issue= 9 | pages= 1308-11 | pmid=24585567 | doi=10.1093/cid/ciu094 | pmc=PMC3982842 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24585567 }} </ref> | * The optimal [[therapy]] for Kaposi's sarcoma depends on multiple factors which include:<ref name="pmid22677687">{{cite journal| author=Fatahzadeh M| title=Kaposi sarcoma: review and medical management update. | journal=Oral Surg Oral Med Oral Pathol Oral Radiol | year= 2012 | volume= 113 | issue= 1 | pages= 2-16 | pmid=22677687 | doi=10.1016/j.tripleo.2011.05.011 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22677687 }} </ref><ref name="pmid24585567">{{cite journal| author=Masur H, Brooks JT, Benson CA, Holmes KK, Pau AK, Kaplan JE et al.| title=Prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Updated Guidelines from the Centers for Disease Control and Prevention, National Institutes of Health, and HIV Medicine Association of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2014 | volume= 58 | issue= 9 | pages= 1308-11 | pmid=24585567 | doi=10.1093/cid/ciu094 | pmc=PMC3982842 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24585567 }} </ref> | ||
:* The [[anatomy|anatomical]] location of the tumor | |||
:* The [[anatomy|anatomical]] location of the [[tumor]] | |||
:* The specific variant of Kaposi's sarcoma | :* The specific variant of Kaposi's sarcoma | ||
:* The rate of distribution and progression of Kaposi's sarcoma lesions | :* The rate of distribution and progression of Kaposi's sarcoma [[lesions]] | ||
:* The patients clinical presentation | :* The patients [[clinical]] presentation | ||
:* The efficacy and potential [[side effect]]s of therapy | :* The [[efficacy]] and potential [[side effect]]s of [[therapy]] | ||
:* The presence or absence of [[HIV]] [[infection]] | :* The presence or absence of [[HIV]] [[infection]] | ||
:* The degree of [[immune]] suppression | :* The degree of [[immune]] suppression | ||
:* The presence of other comorbidities | :* The presence of other [[comorbidities]] | ||
:* The preference and prognosis of the patients | :* The preference and [[prognosis]] of the patients | ||
* Management strategies varies depending on the specific variant of Kaposi's sarcoma such as: | * Management strategies varies depending on the specific variant of Kaposi's sarcoma such as: | ||
:* Classic Kaposi's sarcoma | |||
:* Iatrogenic Kaposi's sarcoma management focuses on modifying the patients [[immunosuppressive therapy]] in addition to local therapeutic interventions. | :*Classic Kaposi's sarcoma management may range from no treatment to either [[radiotherapy]], local [[therapeutic]] interventions, or [[surgery|surgical excision]]. | ||
:* Endemic Kaposi's sarcoma is primarily | :*[[Iatrogenic]] Kaposi's sarcoma management focuses on modifying the patients [[immunosuppressive therapy]] in addition to local [[therapeutic]] interventions. | ||
:*[[Endemic]] Kaposi's sarcoma is primarily managed by systemic [[chemotherapy]] | |||
:* There is no curative treatment for epidemic Kaposi's sarcoma; the mainstay management for such patients is [[Highly active antiretroviral therapy|HAART therapy]] which aims for the control of Kaposi's sarcoma progression. | :* There is no curative treatment for epidemic Kaposi's sarcoma; the mainstay management for such patients is [[Highly active antiretroviral therapy|HAART therapy]] which aims for the control of Kaposi's sarcoma progression. | ||
* '''Local/regional therapy recommended for the management of Kaposi's sarcoma patients may include:''' | * '''Local/regional therapy recommended for the management of Kaposi's sarcoma patients may include:'''<ref name="pmid17762570">{{cite journal |vauthors=Dittmer DP, Krown SE |title=Targeted therapy for Kaposi's sarcoma and Kaposi's sarcoma-associated herpesvirus |journal=Curr Opin Oncol |volume=19 |issue=5 |pages=452–7 |date=September 2007 |pmid=17762570 |pmc=2855645 |doi=10.1097/CCO.0b013e3281eb8ea7 |url=}}</ref> | ||
:* Intralesional vinca-alkaloids, [[bleomycin]], and [[interferon-alpha]] | :* Intralesional vinca-alkaloids, [[bleomycin]], and [[interferon-alpha]] | ||
:* Topical 0.1% [[alitretinoin]] | :* Topical 0.1% [[alitretinoin]] | ||
:* [[Imiquimod]] cream | :* [[Imiquimod]] cream | ||
:* Radiotherapy | :*[[Radiotherapy]] | ||
:* [[Laser therapy]] | :* [[Laser therapy]] | ||
* '''HAART therapy regimens recommended for the management of Kaposi's sarcoma patients may include:''' | * '''HAART therapy regimens recommended for the management of Kaposi's sarcoma patients may include:'''<ref name="pmid14752065">{{cite journal |vauthors=Krown SE |title=Highly active antiretroviral therapy in AIDS-associated Kaposi's sarcoma: implications for the design of therapeutic trials in patients with advanced, symptomatic Kaposi's sarcoma |journal=J. Clin. Oncol. |volume=22 |issue=3 |pages=399–402 |date=February 2004 |pmid=14752065 |doi=10.1200/JCO.2004.08.064 |url=}}</ref><ref name="pmid18453853">{{cite journal |vauthors=Nguyen HQ, Magaret AS, Kitahata MM, Van Rompaey SE, Wald A, Casper C |title=Persistent Kaposi sarcoma in the era of highly active antiretroviral therapy: characterizing the predictors of clinical response |journal=AIDS |volume=22 |issue=8 |pages=937–45 |date=May 2008 |pmid=18453853 |pmc=2730951 |doi=10.1097/QAD.0b013e3282ff6275 |url=}}</ref> | ||
:* Non nucleoside reverse transcriptase (NNRT)-based therapy | |||
:* [[Protease inhibitor]] (PI)-based therapy | :*[[NNRTI|Non nucleoside reverse transcriptase]] ([[NNRTI|NNRT]])-based [[therapy]] | ||
:* [[Protease inhibitor]] (PI)-based [[therapy]] | |||
* '''Chemotherapy regimens recommended for the management of Kaposi's sarcoma patients may include:''' | * '''Chemotherapy regimens recommended for the management of Kaposi's sarcoma patients may include:'''<ref name="pmid2435150">{{cite journal |vauthors=Gelmann EP, Longo D, Lane HC, Fauci AS, Masur H, Wesley M, Preble OT, Jacob J, Steis R |title=Combination chemotherapy of disseminated Kaposi's sarcoma in patients with the acquired immune deficiency syndrome |journal=Am. J. Med. |volume=82 |issue=3 |pages=456–62 |date=March 1987 |pmid=2435150 |doi= |url=}}</ref> | ||
* '''Immune modulators recommended for the management of Kaposi's sarcoma patients may include:''' | :*[[Liposomal doxorubicin]]: [[Liposomal]] [[doxorubicin]] is the preferred first-line systemic [[therapy]]. An [[echocardiogram]] must be obtained prior to the start of [[therapy]] given the risk for [[anthracycline]]-induced [[cardiomyopathy]]. This [[medication]] can also cause [[mucositis]] and [[cytopenias]]. [[Liposomal]] [[doxorubicin]] is typically reserved for advanced [[cutaneous]], [[visceral]], or nodal Kaposi's sarcoma, rather than limited [[cutaneous]] Kaposi's sarcoma. This medication is given at a dose of 20mg/m2 IV every 3 weeks. If a patient develops relapse after treatment with [[liposomal]] [[doxorubicin]] and the initial response lasted for 3 months or greater, a repeat trial of [[liposomal]] [[doxorubicin]] can be done. If the initial response lasted less than 6 months, another agent such as [[Paclitaxel]] should be given. | ||
:* [[Paclitaxel]]: [[Paclitaxel]] is the preferred second-line [[systemic therapy]]. [[Paclitaxel]] is typically reserved for advanced [[cutaneous]], [[visceral]], or nodal Kaposi's sarcoma, rather than limited [[cutaneous]] Kaposi's sarcoma. This [[medication]] is given at a dose of 100mg/m2 IV every 2 weeks and required [[premedication]] with [[dexamethasone]] 10mg give the risk for [[hypersensitivity reaction]] with [[paclitaxel]] [[infusion]]. One major [[adverse effect]] of [[paclitaxel]] is [[peripheral neuropathy]]. | |||
:* [[Etoposide]]: [[Etoposide]] is used in the relapsed/[[refractory]] setting. This is a [[Topoisomerase inhibitor|topoisomerase I inhibitor]] and is used at a dose of 50mg daily for 7 days of each 21-day cycle. | |||
:* [[Pomalidomide]]: [[Pomalidomide]] is an [[immunomodulatory]] agent that is used in the relapsed/[[refractory]] setting. [[Pomalidomide]] is the preferred therapy in the relapsed/[[refractory]] setting compared to the other agents. The dose is 5mg daily for 21 days of a 28-day cycle. [[Adverse effects]] include increased risk for [[thrombosis]], [[cytopenias]], and [[secondary]] [[malignancies]]. [[Thalidomide]] can also be used though the dose is 200mg daily and the [[adverse effect]] profile is worse. | |||
* '''Immune modulators recommended for the management of Kaposi's sarcoma patients may include:'''<ref name="pmid16760382">{{cite journal |vauthors=Rezaee SA, Cunningham C, Davison AJ, Blackbourn DJ |title=Kaposi's sarcoma-associated herpesvirus immune modulation: an overview |journal=J. Gen. Virol. |volume=87 |issue=Pt 7 |pages=1781–804 |date=July 2006 |pmid=16760382 |doi=10.1099/vir.0.81919-0 |url=}}</ref> | |||
:* [[Interferon-alpha]] | :* [[Interferon-alpha]] | ||
* '''Targeted therapies recommended for the management of Kaposi's sarcoma patients may include:''' | * '''Targeted therapies recommended for the management of Kaposi's sarcoma patients may include:'''<ref name="pmid19489649">{{cite journal |vauthors=Sullivan RJ, Pantanowitz L, Dezube BJ |title=Targeted therapy for Kaposi sarcoma |journal=BioDrugs |volume=23 |issue=2 |pages=69–75 |date=2009 |pmid=19489649 |pmc=2707492 |doi= |url=}}</ref> | ||
:* | :* Anti-[[herpes]] [[therapy]] | ||
:* VEGF inhibitors ([[bevacizumab]]) | :*[[VEGF]] inhibitors ([[bevacizumab]]) | ||
:* Tyrosine kinase inhibitors ([[imatinib]]) | :*[[Tyrosine kinase inhibitors]] ([[imatinib]]) | ||
:* Matrix metalloproteinases | :*[[Matrix metalloproteinases]] | ||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Vascular medicine]] | |||
[[Category:Surgery]] | |||
Latest revision as of 18:05, 9 October 2019
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Kaposi's sarcoma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Kaposi's sarcoma medical therapy On the Web |
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American Roentgen Ray Society Images of Kaposi's sarcoma medical therapy |
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Risk calculators and risk factors for Kaposi's sarcoma medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [3]
Overview
The optimal therapy for Kaposi's sarcoma depends on multiple factors. Management strategies varies depending on the specific variant of Kaposi's sarcoma. Classic Kaposi's sarcoma management may range from no treatment to either radiotherapy, local therapeutic interventions, or surgical excision. Iatrogenic Kaposi's sarcoma management focuses on modifying immunosuppressive therapy in addition to local therapeutic interventions. Endemic Kaposi's sarcoma is primarily managed by systemic chemotherapy. However, there is no curative treatment for epidemic Kaposi's sarcoma; the mainstay management for such patients is HAART therapy which aims for the control of Kaposi's sarcoma progression.
Medical Therapy
- 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 preference and prognosis of the patients
- Management strategies varies depending on the specific variant of Kaposi's sarcoma such as:
- Classic Kaposi's sarcoma management may range from no treatment to either radiotherapy, local therapeutic interventions, or surgical excision.
- Iatrogenic Kaposi's sarcoma management focuses on modifying the patients immunosuppressive therapy in addition to local therapeutic interventions.
- Endemic Kaposi's sarcoma is primarily managed by systemic chemotherapy
- There is no curative treatment for epidemic Kaposi's sarcoma; the mainstay management for such patients is HAART therapy which aims for the control of Kaposi's sarcoma progression.
- Local/regional therapy recommended for the management of Kaposi's sarcoma patients may include:[3]
- Intralesional vinca-alkaloids, bleomycin, and interferon-alpha
- Topical 0.1% alitretinoin
- Imiquimod cream
- Radiotherapy
- Laser therapy
- HAART therapy regimens recommended for the management of Kaposi's sarcoma patients may include:[4][5]
- Non nucleoside reverse transcriptase (NNRT)-based therapy
- Protease inhibitor (PI)-based therapy
- Chemotherapy regimens recommended for the management of Kaposi's sarcoma patients may include:[6]
- Liposomal doxorubicin: Liposomal doxorubicin is the preferred first-line systemic therapy. An echocardiogram must be obtained prior to the start of therapy given the risk for anthracycline-induced cardiomyopathy. This medication can also cause mucositis and cytopenias. Liposomal doxorubicin is typically reserved for advanced cutaneous, visceral, or nodal Kaposi's sarcoma, rather than limited cutaneous Kaposi's sarcoma. This medication is given at a dose of 20mg/m2 IV every 3 weeks. If a patient develops relapse after treatment with liposomal doxorubicin and the initial response lasted for 3 months or greater, a repeat trial of liposomal doxorubicin can be done. If the initial response lasted less than 6 months, another agent such as Paclitaxel should be given.
- Paclitaxel: Paclitaxel is the preferred second-line systemic therapy. Paclitaxel is typically reserved for advanced cutaneous, visceral, or nodal Kaposi's sarcoma, rather than limited cutaneous Kaposi's sarcoma. This medication is given at a dose of 100mg/m2 IV every 2 weeks and required premedication with dexamethasone 10mg give the risk for hypersensitivity reaction with paclitaxel infusion. One major adverse effect of paclitaxel is peripheral neuropathy.
- Etoposide: Etoposide is used in the relapsed/refractory setting. This is a topoisomerase I inhibitor and is used at a dose of 50mg daily for 7 days of each 21-day cycle.
- Pomalidomide: Pomalidomide is an immunomodulatory agent that is used in the relapsed/refractory setting. Pomalidomide is the preferred therapy in the relapsed/refractory setting compared to the other agents. The dose is 5mg daily for 21 days of a 28-day cycle. Adverse effects include increased risk for thrombosis, cytopenias, and secondary malignancies. Thalidomide can also be used though the dose is 200mg daily and the adverse effect profile is worse.
- Immune modulators recommended for the management of Kaposi's sarcoma patients may include:[7]
- Targeted therapies recommended for the management of Kaposi's sarcoma patients may include:[8]
- Anti-herpes therapy
- VEGF inhibitors (bevacizumab)
- Tyrosine kinase inhibitors (imatinib)
- Matrix metalloproteinases
References
- ↑ Fatahzadeh M (2012). "Kaposi sarcoma: review and medical management update". Oral Surg Oral Med Oral Pathol Oral Radiol. 113 (1): 2–16. doi:10.1016/j.tripleo.2011.05.011. PMID 22677687.
- ↑ Masur H, Brooks JT, Benson CA, Holmes KK, Pau AK, Kaplan JE; et al. (2014). "Prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Updated Guidelines from the Centers for Disease Control and Prevention, National Institutes of Health, and HIV Medicine Association of the Infectious Diseases Society of America". Clin Infect Dis. 58 (9): 1308–11. doi:10.1093/cid/ciu094. PMC 3982842. PMID 24585567.
- ↑ Dittmer DP, Krown SE (September 2007). "Targeted therapy for Kaposi's sarcoma and Kaposi's sarcoma-associated herpesvirus". Curr Opin Oncol. 19 (5): 452–7. doi:10.1097/CCO.0b013e3281eb8ea7. PMC 2855645. PMID 17762570.
- ↑ Krown SE (February 2004). "Highly active antiretroviral therapy in AIDS-associated Kaposi's sarcoma: implications for the design of therapeutic trials in patients with advanced, symptomatic Kaposi's sarcoma". J. Clin. Oncol. 22 (3): 399–402. doi:10.1200/JCO.2004.08.064. PMID 14752065.
- ↑ Nguyen HQ, Magaret AS, Kitahata MM, Van Rompaey SE, Wald A, Casper C (May 2008). "Persistent Kaposi sarcoma in the era of highly active antiretroviral therapy: characterizing the predictors of clinical response". AIDS. 22 (8): 937–45. doi:10.1097/QAD.0b013e3282ff6275. PMC 2730951. PMID 18453853.
- ↑ Gelmann EP, Longo D, Lane HC, Fauci AS, Masur H, Wesley M, Preble OT, Jacob J, Steis R (March 1987). "Combination chemotherapy of disseminated Kaposi's sarcoma in patients with the acquired immune deficiency syndrome". Am. J. Med. 82 (3): 456–62. PMID 2435150.
- ↑ Rezaee SA, Cunningham C, Davison AJ, Blackbourn DJ (July 2006). "Kaposi's sarcoma-associated herpesvirus immune modulation: an overview". J. Gen. Virol. 87 (Pt 7): 1781–804. doi:10.1099/vir.0.81919-0. PMID 16760382.
- ↑ Sullivan RJ, Pantanowitz L, Dezube BJ (2009). "Targeted therapy for Kaposi sarcoma". BioDrugs. 23 (2): 69–75. PMC 2707492. PMID 19489649.