title: Antiangiogenic therapy with pioglitazone, rofecoxib, and trofosfamide in a patient with endemic kaposi sarcoma.
abstract: 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.
authors.affiliation: Department of Dermatology, University of Regensburg, Regensburg, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Coras
authors.forename: Christian
authors.initials: C
authors.lastname: Hafner
authors.forename: Albrecht
authors.initials: A
authors.lastname: Reichle
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hohenleutner
authors.forename: Rolf-Markus
authors.initials: RM
authors.lastname: Szeimies
authors.forename: Michael
authors.initials: M
authors.lastname: Landthaler
authors.forename: Thomas
authors.initials: T
authors.lastname: Vogt
mesh_terms: 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
chemical_list: D020533:Angiogenesis Inhibitors; D007783:Lactones; D013450:Sulfones; D045162:Thiazolidinediones; C116926:rofecoxib; D003520:Cyclophosphamide; C003726:trofosfamide; D000077205:Pioglitazone