Antiangiogenic therapy with pioglitazone, rofecoxib, and trofosfamide in a patient with endemic kaposi sarcoma.
BACKGROUND
Kaposi sarcoma (KS) in patients who are seronegative and seropositive for human immunodeficiency virus is currently the most common malignant tumor in central Africa. It accounts for 50% of all tumors reported in central African countries. Owing to the rising number of patients and the limitations of current therapies, there is an urgent demand for new strategies to treat KS.


METHODS
We describe a 42-year-old dark-skinned patient from Mozambique with endemic KS. The tumor was first diagnosed 8 years earlier when an ulcerated nodule appeared at his right ankle joint. Subsequently, multiple reddish brown nodules appeared on both feet and the left thigh. Results of dermatohistopathological analysis confirmed the diagnosis of KS. Topical therapies including cryotherapy, carbon-dioxide laser, and photodynamic therapy could not prevent new recurrences and further cutaneous dissemination. Therefore, a novel antiangiogenic systemic therapy was started that was previously shown to be effective in angiosarcomas other than KS. The regimen consists of the biomodulators pioglitazone hydrochloride and rofecoxib combined with a metronomic (daily) low-dose chemotherapy with trofosfamide. We observed a partial remission, which has been stable for 18 months. No significant toxic effects were observed.


CONCLUSIONS
The suggested antiangiogenic strategy has the potential to become a cheap, practical, feasible alternative treatment for endemic KS, particularly suitable for the outpatient setting.
Coras
Brigitte
B
Department of Dermatology, University of Regensburg, Regensburg, Germany.
Hafner
Christian
C
Reichle
Albrecht
A
Hohenleutner
Ulrich
U
Szeimies
Rolf-Markus
RM
Landthaler
Michael
M
Vogt
Thomas
T
D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D019353:Endemic Diseases; D006801:Humans; D007783:Lactones / Q000627:therapeutic use*; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D000077205:Pioglitazone; D012514:Sarcoma, Kaposi / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D013450:Sulfones / Q000627:therapeutic use*; D045162:Thiazolidinediones / Q000627:therapeutic use*; D016896:Treatment Outcome
D020533:Angiogenesis Inhibitors; D007783:Lactones; D013450:Sulfones; D045162:Thiazolidinediones; C116926:rofecoxib; D003520:Cyclophosphamide; C003726:trofosfamide; D000077205:Pioglitazone