Photofrin photodynamic therapy for treatment of AIDS-related cutaneous Kaposi's sarcoma.
OBJECTIVE
Kaposi's sarcoma, the most common malignancy in AIDS patients, often presents with painful cutaneous lesions that are difficult to treat effectively despite a wide variety of therapeutic approaches. We used photodynamic therapy in an attempt to provide effective palliative treatment for this disease.


METHODS
Photodynamic therapy utilizes the activation by light of a photosensitizing drug that preferentially accumulates in tumor tissue such as Kaposi's sarcoma. We enrolled 25 patients who received 1.0 mg/kg of Photofrin 48 h before exposure to 100-400 J/cm2 of 630 nm light.


RESULTS
Of the 348 lesions treated, 289 were evaluable: 32.5% had complete clinical response, 63.3% had partial clinical response and 4.2% were clinical failures. There was a strong correlation between response and light dose: 54% of lesions achieved a complete clinical response at optimum light dose (> 250 J/cm2). There was no correlation of response with CD4 cell count nor was there a change in CD4 cell count post-treatment. At 400 J/cm2 full field scabbing and necrosis occurred in 90% of the treated fields. Thus, the maximum tolerated dose was determined to be 300 J/cm2. At light doses of 250 J/cm2 and below the toxicities were limited to erythema and edema in the treatment field. Forty-three biopsies were taken 0.5 h to 4 months post-treatment. These showed little change in the B and T cell infiltrates identified. Kaposi's sarcoma cells disappeared post-treatment in certain lesions.


CONCLUSIONS
Photofrin is effective palliative treatment for HIV-associated Kaposi's sarcoma.
Bernstein
Z P
ZP
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Wilson
B D
BD
Oseroff
A R
AR
Jones
C M
CM
Dozier
S E
SE
Brooks
J S
JS
Cheney
R
R
Foulke
L
L
Mang
T S
TS
Bellnier
D A
DA
Dougherty
T J
TJ
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010166:Palliative Care; D010778:Photochemotherapy / Q000009:adverse effects; D012514:Sarcoma, Kaposi / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012878:Skin Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology
D000970:Antineoplastic Agents; D017323:Dihematoporphyrin Ether