The therapeutic effect of intralesional interferon in classical Kaposi's sarcoma

Diagnosis and treatment of classic and iatrogenic Kaposi's sarcoma: Italian recommendations

Kaposi's sarcoma (KS) is a lymphangioproliferative disorder associated with Human herpesvirus 8 (HHV8) infection. Four clinical subtypes are recognized: classic, endemic, epidemic (HIV-related) and iatrogenic. KS diagnosis is based on clinical features, histopathological assessment, and HHV8 serology. Classic KS is usually skin-limited and has a chronic course, while the iatrogenic variant may show mucosal, nodal or visceral involvement. Clinical staging is fundamental to guide the management. Localized disease may be treated with different local therapies, even if there are no randomized trials comparing these different modalities. Aggressive, disseminated KS and cases with visceral involvement usually require systemic chemotherapy, most commonly vinblastine, bleomycin or paclitaxel. Iatrogenic KS needs immunosuppression tapering/withdrawal and, if possible, switch to m-TOR inhibitors in post-transplant KS. The present work by a panel of Italian experts provides guidelines on KS diagnosis and management based on a critical review of the literature and a long and extensive personal experience.

Kaposi Sarcoma Updates

Kaposi sarcoma (KS) is an angioproliferative mesenchymal neoplasm caused by Kaposi sarcoma-related herpesvirus. This review outlines our current understanding of the epidemiology, pathogenesis, clinical presentation, and staging for this disease. Recent research has informed a more comprehensive understanding of the epidemiology of KS in the post-antiretroviral therapy era, and highlights the continued need to better characterize the African endemic subtype. Advances in clinical oncology, including checkpoint inhibitors and new skin-directed therapies, have translated into exciting new developments for the future of KS treatment options.

Long-Term Response of Classic Kaposi's Sarcoma to Intralesional Doxorubicin: A Case Report

Classic Kaposi's sarcoma (KS) is a disease with low mortality but high morbidity. The optimum treatment of KS depends upon several factors, including location of lesions, disease progression, severity of symptoms and patient preference. We report the long-term response to the use of intralesional doxorubicin to successfully treat a large cutaneous lesion of KS on a patient refractory to traditional treatments.

Treatments for classic Kaposi sarcoma: a systematic review of the literature

BACKGROUND

Treatment guidelines are lacking for classic Kaposi sarcoma.

OBJECTIVE

We sought to review the evidence on efficacy of treatments for classic Kaposi sarcoma.

METHODS

Articles published in English or French in MEDLINE, Trip, Cochrane Library, and Pascal databases from 1980 to December 2010 were screened. Studies reporting at least 5 patients treated for histologically confirmed classic Kaposi sarcoma were selected. Primary outcome was a decrease in the number or size of lesions or of lymphedema. We reviewed 26 articles matching the inclusion criteria for methodologic quality, classifying them according to World Health Organization criteria.

RESULTS

The percentage of patients with a 50% or greater decrease in lesions was 71% to 100% for pegylated liposomal doxorubicin, 58% to 90% for vinca-alkaloids, 74% to 76% for etoposide, 93% to 100% for taxanes, 100% for gemcitabine, 97% for the combination of vinblastine and bleomycin, 71% to 100% for interferon alfa-2, 43% for thalidomide, and 12% for indinavir. For local treatments, a decrease of 50% or greater was achieved in 62% of lesions for intralesional vincristine, 50% to 90% for intralesional interferon alfa-2, 56% for imiquimod, and 25% for nicotine patches. A complete response was attained in 60% to 93% of lesions with radiotherapy.

LIMITATIONS

Eligible trials were of poor quality. The lack of standardized classification of disease activity and clinical outcomes precluded the comparison of studies.

CONCLUSION

The evidence for efficacy of any particular intervention is of low quality and does not support recommending any particular therapeutic strategy. Further studies are required and it will be important to standardize the assessment of disease activity and clinical response.

A case of classical Kaposi's sarcoma of the penis showing a good response to high-energy pulsed carbon dioxide laser therapy

Isolated Kaposi's sarcoma (KS) of the glans penis is rare; only 37 cases are reported in the literature. Treatment of KS consists mostly of old modalities, some old methods in updated improved versions, and some new and experimental therapies. We report a case of isolated classical Kaposi's sarcoma involving multiple sites of the penis in a 54-year-old man who was treated with high-energy pulsed carbon dioxide (CO2) laser therapy, resulting in complete resolution of the lesions and no evidence of recurrence.

Advances in Kaposi's sarcoma

KS remains a challenge to clinicians and investigators more than a century after its initial description. Debate continues as to the cell of origin, as well as whether or not it is a true cancer. KS appears to be an opportunistic neoplasm, which in its earliest phase retains some features of a benign hyperproliferative process, but in its late stages behaves like an aggressive malignancy. Pathogenesis seems to involve a predisposed individual (genetically susceptible or immunologically compromised) who comes into contact with an infectious agent, most likely a virus. Cytokines appear to play a major role in the growth of the tumor. The exact role of the KSHV in this process will likely be the subject of much investigation in the future.

Treatment of angioblastoma with recombinant interferon-alpha 2

Interferon-alpha 2 has been used successfully to treat angiomatous lesions such as Kaposi sarcoma and life-threatening hemangiomas, possibly by its antiangiogenetic activity. We report the successful use of this agent in a child with an angioblastoma of the right leg.

Dermatologic therapy: 1993

This article reviews some therapeutic results reported in the English-language literature during 1993. Readers should review the original article in full before attempting any experimental or controversial therapy.