Iatrogenic Kaposi Sarcoma When Immunosuppression Modification Has Not Achieved Lesion Regression
For patients with iatrogenic Kaposi sarcoma, adjusting the underlying immunosuppressive regimen is the first step. When that step — including switching to alternative immunosuppressants in organ transplant recipients — does not bring about the expected regression of lesions, a structured next-line approach for the cutaneous lesions themselves is indicated.
Previous Treatment — Failure Condition
Modification of immunosuppression (discontinuation, reduction, or switching immunosuppressants, including transition to mTOR inhibitors such as sirolimus or everolimus in calcineurin inhibitor-based transplant regimens) did not achieve regression of Kaposi's sarcoma lesions, particularly in early or non-aggressive disease stages.
Next-Line Approach (Partial Overview)
This protocol addresses individual cutaneous lesions directly. Local therapeutic modalities — including radiotherapy, which is among the most effective options given KS's high radiosensitivity — form a core part of this step. Additional local approaches are available depending on lesion characteristics and clinical factors. The complete selection criteria, sequencing, and all options are contained in the full protocol.
Clinical Goals
Treatment aims for reduction in tumor size, thickness, and coloration, along with reduction of edema of the cutaneous lesions.
References
DOI: 10.1111/ddg.14788
- In organ transplant patients with KS who do not respond to a change in immunosuppression, KS is treated similarly to classic KS.
- Individual lesions can also be treated locally.
- Due to the high radiosensitivity of KS, radiotherapy is among the most effective local treatments for all KS subtypes.
- In addition to subjective parameters, the size, thickness and coloration of the tumors as well as the presence of edema serve as criteria.
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