title: Treatment of poor prognosis epidemic Kaposi's sarcoma with doxorubicin, bleomycin, vindesine and recombinant human granulocyte-monocyte colony stimulating factor (rh GM-CSF).
abstract: The efficacy and toxicity of doxorubicin, bleomycin and vindesine in epidemic Kaposi's sarcoma, and the role of rh GM-CSF in chemotherapy-induced neutropenia were evaluated in this Phase II study. Patients with progressive Kaposi's sarcoma were eligible, and were staged according to ACTG criteria. Treatment consisted of 20 mg/m2 doxorubicin, and a fixed dose of 15 mg bleomycin and 4 mg vindesine every 2 weeks. All patients continued antiretroviral medication with severe myelosuppression, patients received subcutaneous 5 micrograms/kg rh GM-CSF (Leucomax) from days 2-12. Response and toxicity were measured according to ACTG and WHO criteria. 27 patients were evaluable, 25 patients classified as having a poor prognosis. The response rate was 70% (3 CR, 16 PR), the duration of response was 18 weeks (range 8-25) and the median survival 30 weeks (range 4-63+). The cause of death was mostly opportunistic infection. 4 patients died of pulmonary Kaposi's sarcoma. The toxicity of this regimen was mainly myelosuppression and 13 patients were treated with rh GM-CSF. Complete recovery of the white blood cells occurred in seven of the 27 courses of rh GM-CSF (26%). No bacterial infections were recorded, but 5 patients (19%) developed an opportunistic infection during treatment. Peripheral neuropathy occurred in 16% of patients. Combination chemotherapy is effective in poor prognosis Kaposi's sarcoma but has a shortlasting effect. The main toxicity of this treatment is severe myelosuppression which can be ameliorated by rh GM-CSF. It remains to be established whether rh GM-CSF is also able to reduce the incidence of opportunistic infections.
authors.affiliation: Division of Medical Oncology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: Bakker
authors.forename: S A
authors.initials: SA
authors.lastname: Danner
authors.forename: C H
authors.initials: CH
authors.lastname: ten Napel
authors.forename: F P
authors.initials: FP
authors.lastname: Kroon
authors.forename: H G
authors.initials: HG
authors.lastname: Sprenger
authors.forename: R
authors.initials: R
authors.lastname: van Leusen
authors.forename: P L
authors.initials: PL
authors.lastname: Meenhorst
authors.forename: A
authors.initials: A
authors.lastname: Muusers
authors.forename: C H
authors.initials: CH
authors.lastname: Veenhof
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D012514:Sarcoma, Kaposi / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome; D014751:Vindesine / Q000008:administration & dosage
chemical_list: D011994:Recombinant Proteins; D001761:Bleomycin; D004317:Doxorubicin; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D014751:Vindesine