Emerging treatments for epidemic (AIDS-related) Kaposi's sarcoma.
Kaposi's sarcoma (KS) is an opportunistic tumor that develops with increased frequency (100,000-fold) after HIV infection. KS causes significant morbidity from mucocutaneous involvement and mortality from complications of visceral sites of disease such as the lungs, gastrointestinal tract, and the liver. Progressive unraveling of the KS pathogenesis has lead to the development of novel therapeutic approaches. Newest therapies are first evaluated in patients with limited tumor burden. These include: 1) inhibitors of angiogenesis such as vascular endothelial growth factor signaling inhibitor (SU 5416), and several other inhibitors of angiogenesis such as the dipeptide IM 862, TNP-470, Col-3, and thalidomide; 2) topical and systemic retinoids; 3) antiviral agents specific for Kaposi's sarcoma herpesvirus and human herpesvirus-8, or HIV; and 4) pregnancy-related factors. Patients with advanced disease such as widespread mucocutaneous disease, lymphedema, and visceral disease are treated most effectively with cytotoxic agents. The most active agents include liposomal anthracyclines, paclitaxel, vinca alkaloids, and bleomycin. The combination of liposomal anthracyclines and paclitaxel, with and without the most promising biologicals, should now be studied to further reduce the toxicity, and enhance the antitumor effects. Furthermore, identification of risk factors for KS should serve to explore prophylactic therapies.
McGarvey
M E
ME
University of Southern California, Los Angeles Department of Medicine and Pathology, Norris Cancer Hospital and Research Institute 90033, USA.
Tulpule
A
A
Cai
J
J
Zheng
T
T
Masood
R
R
Espina
B
B
Arora
N
N
Smith
D L
DL
Gill
P S
PS
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000628:therapy; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D043168:Angiostatins; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D003094:Collagen / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D043169:Endostatins; D015497:HIV-1 / Q000187:drug effects; D019288:Herpesvirus 8, Human / Q000187:drug effects; D010446:Peptide Fragments / Q000627:therapeutic use; D010958:Plasminogen / Q000627:therapeutic use; D012514:Sarcoma, Kaposi / Q000150:complications / Q000628:therapy* / Q000821:virology; D019714:Tissue Inhibitor of Metalloproteinases / Q000627:therapeutic use; D014212:Tretinoin / Q000627:therapeutic use
D000970:Antineoplastic Agents; D000998:Antiviral Agents; D006063:Chorionic Gonadotropin; D043169:Endostatins; D010446:Peptide Fragments; D019714:Tissue Inhibitor of Metalloproteinases; D014212:Tretinoin; D043168:Angiostatins; D010958:Plasminogen; D003094:Collagen