Ophthalmologic Manifestations of Kaposi Sarcoma Medication

  • Author: Jacqueline Freudenthal, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 22, 2010
 

Medication Summary

Most ophthalmologists may want to delegate the administration of chemotherapeutic agents to chemotherapists or oncologists. The medical therapy for disseminated Kaposi sarcoma consists of either Adriamycin, bleomycin sulfate, and vinblastine sulfate (ABV) combination or liposomal daunorubicin alone. Liposomal doxorubicin is usually reserved for those patients who fail ABV combination or who are intolerant to ABV therapy. Other second-line therapies include the use of paclitaxel and interferon alfa-n3.

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Antineoplastics

Class Summary

These agents inhibit cell growth and proliferation.

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Vinblastine sulfate (Velban)

 

Alkaloid extract of Catharanthus roseus. FDA indications for use of vinblastine are Kaposi sarcoma, choriocarcinoma, histiocytosis X, lymphocytic lymphoma, mycosis fungoides, breast carcinoma, and testicular carcinoma. Mechanism of action is to arrest growing cells in metaphase by inhibiting formation of microtubule assembly during spindle formation. For treatment of Kaposi sarcoma, ABV is conventional combination treatment used. Major route of elimination is through excretion. A small portion is eliminated through urine. Main route of administration is IV.

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Bleomycin sulfate (Blenoxane)

 

Cytotoxic glycopeptide extracted from a strain of Streptomyces verticillus. Commonly used in combination with Adriamycin and vinblastine. Inhibits DNA, RNA, and protein synthesis. Major route of elimination is through urine. Serum concentrations may increase in patients with poor creatinine clearance.

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Doxorubicin hydrochloride (Adriamycin, Doxil)

 

Cytotoxic anthracycline extracted from Streptomyces peucetius. Not FDA approved for the treatment of Kaposi sarcoma but often used in combination with bleomycin and vinblastine.

Mechanism of action is by intercalation of anthracycline with DNA. Subsequently, this blocks DNA and RNA polymerases, resulting in the inhibition of cell growth and proliferation. Major route of elimination is via biliary excretion.

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Daunorubicin citrate liposome (DaunoXome)

 

Anthracycline antibiotic extracted from S peucetius. Indicated for treatment of Kaposi sarcoma. Liposomal version of daunorubicin greatly enhances functional characteristics of the treatment by decreasing plasma clearance and a smaller volume of distribution. Characteristics translate into longer drug exposure. Daunorubicin is a first-line drug for advanced HIV-Kaposi sarcoma. Not recommended for mild involvement.

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Paclitaxel (Taxol)

 

Extract of Taxus baccata. Indicated for second-line treatment of AIDS-related Kaposi sarcoma. Mechanism of action is to promote polymerization of microtubules and to inhibit depolymerization. Prevention of microtubule dynamics results in the inability of the cell to undergo mitosis. Major route of elimination is through hepatic clearance. All patients should be premedicated with dexamethasone 10 mg PO 12 h before treatment, diphenhydramine 50 mg IV 30 min prior to treatment, and cimetidine or ranitidine IV 30 min before treatment.

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Interferons

Class Summary

These agents are naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. Alfa, beta, and gamma interferons may be given topically, systemically, and intralesionally.

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Interferon alfa-2a (Roferon A), alfa-2b (Intron A), alfa-n3 (Alferon N)

 

Derived from pooled units of human leukocytes induced by Sendai virus. Human sources of leukocytes are screened carefully for infectious agents (Sendai virus, HIV-1, HTLV-I, HBV, HSV-1, CMV, and EBV).

FDA indication is for condyloma acuminata. Off-label uses include bladder carcinoma, ovarian epithelial carcinoma, renal carcinoma, chronic active hepatitis, AIDS-related Kaposi sarcoma, chronic myelocytic leukemia, hairy cell leukemia, non-Hodgkin lymphoma, malignant melanoma, multiple myeloma, mycosis fungoides, laryngeal papillomatosis, essential thrombocytosis, and carcinoid tumors.

Interferons are secreted normally by cells in response to viral infections. Binding of interferon to receptors initiates of cascade of events that ultimately involves inhibition of viral replication, suppression of mitosis, and other enhancements to the immune system.

Dose of interferon alfa will vary depending on type and brand chosen. SC route is recommended in those with coagulopathies.

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Contributor Information and Disclosures
Author

Jacqueline Freudenthal, MD  Co-Investigator, Ophthalmic Consultants Centre, Toronto

Jacqueline Freudenthal, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, and Canadian Ophthalmological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Kevin Ryan Yuhan, MD  Attending Physician, Cornea, Cataract, Refractive and External Diseases, Southern California Permanente Medical Group

Kevin Ryan Yuhan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Timothy T You, MD  Consulting Surgeon in Ophthalmology, Private Practice

Timothy T You, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Retina Specialists

Disclosure: Nothing to disclose.

Specialty Editor Board

Anastasios J Kanellopoulos, MD  Assistant Program Director, Clinical Associate Professor, Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York University

Anastasios J Kanellopoulos, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Eye Bank Association of America, and International Society of Refractive Surgery

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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Section of eyelid with Kaposi sarcoma lesion under high magnification. This tissue section demonstrates increased angiogenesis and spindle-shaped cells. Courtesy of Ben Glasgow, MD, University of California, Los Angeles, Department of Ophthalmology, Jules Stein Eye Institute.
Section of eyelid with Kaposi sarcoma lesion under high magnification. This tissue section demonstrates endothelium-lined vascular channels and proliferation of spindle-shaped cells. Increased angiogenesis with erythrocyte extravasation is observed. Courtesy of Ben Glasgow, MD, University of California, Los Angeles, Department of Ophthalmology, Jules Stein Eye Institute.
The inferior conjunctiva is involved more commonly than the superior conjunctiva in Kaposi sarcoma. Courtesy of Gary N Holland, MD, University of California, Los Angeles, Department of Ophthalmology, Jules Stein Eye Institute.
Kaposi sarcoma involvement of the eyelid. Courtesy of Gary N Holland, MD, University of California, Los Angeles, Department of Ophthalmology, Jules Stein Eye Institute.
 
 
 
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