Sections

Medication

Medication Summary

The goals of pharmacotherapy for Kaposi sarcoma (KS) are to eradicate the sarcoma, reduce morbidity, and prevent complications.

Class Summary

Taxanes inhibit cell growth and differentiation by preventing depolymerization of microtubules.

Paclitaxel (Taxol)

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Promotes the assembly of microtubules from tubulin dimers and stabilizes microtubules by preventing depolymerization. FDA-approved for the treatment of patients with AIDS-related KS.

Class Summary

Anthracyclines inhibit cell growth and differentiation by inhibiting topoisomerase II and producing free radicals, which may cause the destruction of DNA.

Doxorubicin HCL liposome (Doxil)

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Binds to DNA and impairs nucleic acid synthesis. Doxil is doxorubicin encapsulated in a pegylated liposome. This technology allows for longer area under the time-concentration curve than with free doxorubicin. Additionally allows for increased selective drug delivery to tumor tissues. Doxorubicin and daunorubicin currently serve as first-line treatment for individuals with advanced KS. An ongoing clinical trial being conducted by the Eastern Cooperative Oncology Group (ECOG) is comparing paclitaxel to Doxil in chemo-naïve patients with advanced symptomatic KS.

Daunorubicin citrate liposome (DaunoXome)

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Liposomal preparation of daunorubicin. Inhibits DNA and RNA synthesis by intercalating between DNA base pairs.

Class Summary

Interferons are naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. Alpha-, beta-, and gamma-interferons may be administered topically, systemically, and intralesionally.

Interferon alfa 2b (Intron)

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Thought to exert activity in KS through antiproliferative tumor effect and antiviral properties. Protein product manufactured by recombinant DNA technology. Mechanism of antitumor activity is not understood clearly; however, direct antiproliferative effects against malignant cells and modulation of host immune response may play important roles.

Class Summary

Retinoids may reduce potential for malignant degeneration.

Alitretinoin gel 0.1% (Panretin)

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Naturally occurring endogenous retinoid. Inhibits growth of KS by binding to retinoid receptors.

Class Summary

Vinca alkaloids inhibit microtubule formation, which in turn disrupts the formation of mitotic spindle, causing cell proliferation to arrest at metaphase.

Vinblastine sulfate (Velban)

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Vinca alkaloid derived from the periwinkle plant. Induces arrest of cell division by inhibiting microtubule formation.

Questions

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Media Gallery

Endoscopic view of a Kaposi sarcoma lesion situated in the gastric antrum.
Epidemic Kaposi sarcoma (KS). Large violaceous truncal nodules with typical linear and symmetric distribution pattern.
Kaposi sarcoma (KS), facial. Confluent, violaceous nodules involving the chest wall; extensive facial involvement with accompanied edema.

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Author

Jessica Katz, MD, PhD Senior Medical Director, Hematology, Global Drug Development, Bristol Myers Squibb

Jessica Katz, MD, PhD is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Employee of Bristol Myers Squibb.

Coauthor(s)

Julianne Hibbs, DO Fellow in Hematology and Medical Oncology, Lankenau Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edwin Choy, MD, PhD Associate Professor of Medicine, Harvard Medical School; Director of Sarcoma Oncology, Department of Medicine, Division of Hematology/Oncology, Dana Farber/Harvard Cancer Center, Massachusetts General Hospital

Edwin Choy, MD, PhD is a member of the following medical societies: American Society of Clinical Oncology, Children's Oncology Group, Connective Tissue Oncology Society, Radiation Therapy Oncology Group, Sarcoma Alliance for Research through Collaboration

Disclosure: Received research grant from: Amgen, Mirati, Novartis, Eli Lilly, Exelexis, Astra Zeneca, Iterion, and IMDZ.

Additional Contributors

Joseph A Sparano, MD Professor, Department of Medicine (Oncology), Professor, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine; Associate Chairman for Clinical Research, Department of Oncology, Montefiore Medical Center; Associate Director for Clinical Research, Albert Einstein Cancer Center

Joseph A Sparano, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology

Disclosure: Nothing to disclose.

Lewis J Rose, MD Clinical Associate Professor of Medical Oncology, Division of Regional Cancer Care, Kimmel Cancer Center, Thomas Jefferson University Hospital; Consulting Staff, LRCRZ Associates

Lewis J Rose, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Hematology, Pennsylvania Medical Society, Phi Beta Kappa, Philadelphia County Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Ari D Fishman, MD Fellow, Department of Medical Oncology, Albert Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine

Ari D Fishman, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and American Society of Hematology

Disclosure: Nothing to disclose.

Classification	Affected Population	Clinical Course
AIDS related	HIV-infected persons (usually those with a low CD4+ count usually)	Most aggressive (survival improved with antiretroviral therapy)
Classical	Eastern European or Mediterranean men	Indolent (progression over years to decades)
Endemic	Subsaharan African children and adults	Somewhat aggressive
Iatrogenic	Patients receiving immunosuppressive therapy (eg, following organ transplantation, for autoimmune disease)	Somewhat aggressive

Kaposi Sarcoma Medication

Medication Summary

Taxanes

Class Summary

Paclitaxel (Taxol)

Paclitaxel (Taxol)

Anthracyclines

Class Summary

Doxorubicin HCL liposome (Doxil)

Doxorubicin HCL liposome (Doxil)

Daunorubicin citrate liposome (DaunoXome)

Daunorubicin citrate liposome (DaunoXome)

Interferons

Class Summary

Interferon alfa 2b (Intron)

Interferon alfa 2b (Intron)

Retinoids

Class Summary

Alitretinoin gel 0.1% (Panretin)

Alitretinoin gel 0.1% (Panretin)

Vinca alkaloids

Class Summary

Vinblastine sulfate (Velban)

Vinblastine sulfate (Velban)

References

Tables

Contributor Information and Disclosures

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