Endemic Kaposi Sarcoma When Local Therapy Has Not Achieved Adequate Lesion Regression
This protocol applies to endemic Kaposi sarcoma where an initial course of local therapy directed at individual cutaneous lesions has not produced the expected regression.
The first line comprised local approaches to individual cutaneous Kaposi sarcoma lesions, which may have included radiotherapy, cryotherapy, intralesional agents, topical therapies, and electrochemotherapy. In cases of KS-associated lymphedema of the extremities, compression therapy, lymphatic drainage, and physiotherapy may also have been applied.
Escalation to systemic treatment is indicated when these local measures have not achieved the expected goals: clinically confirmed reduction in the size, thickness, and coloration of lesions, along with reduction of edema.
Systemic therapy is the indicated next step. The primary approach involves intravenous chemotherapy, with additional systemic options also available. The complete protocol — covering agent selection, scheduling, and alternatives — is available in full via the link below.
The therapeutic aim is partial remission of Kaposi sarcoma lesions over a course of infusions, defined as reduction in tumor size, thickness, and coloration, together with reduction of edema.
References
DOI: 10.1111/ddg.14788
- For systemic therapy of KS, chemotherapy with pegylated liposomal doxorubicin should be the first choice.
- Pegylated liposomal doxorubicine at a dose of 20 mg/m2 body surface area i.v. every 2–3 weeks can achieve partial remissions in up to 60–80 % of treated patients.
- An alternative for doxorubicine is liposomal daunorubicine, which is probably somewhat less effective.
- Liposomal daunorubicine (DaunoXome®) is given at a dose of 40 mg/m2 KO i.v. every two weeks.
- Classical KS shows remission rates of 60-70 % on class I interferons (IFN-α2a, 2b; IFN-β) at doses of 3–9 million I.U. 3 x/week s.c.
- In most cases, a profound partial remission is achieved after about 3–6 infusions, whereas some patients require more infusions to achieve a response.
- In addition to subjective parameters, the size, thickness and coloration of the tumors as well as the presence of edema serve as criteria.