title: Prospective stage-stratified approach to AIDS-related Kaposi's sarcoma.
abstract: OBJECTIVE
  Combination antiretroviral therapy (cART) is standard of care for patients with HIV diagnosed with Kaposi's sarcoma (KS), but the current role of systemic chemotherapy is undefined.
  
  
  METHODS
  Since 1998, a prospective stage-stratified approach has been adopted for 469 patients with HIV with KS. Patients with early-stage (T0) KS are treated with cART alone; patients with advanced-stage (T1) KS receive cART plus liposomal anthracycline chemotherapy. Clinical characteristics, overall survival, and KS progression-free survival were analyzed according to stage at presentation and treatment received.
  
  
  RESULTS
  A total of 303 patients presented with T0 stage KS, including 237 who were not receiving cART, and 166 patients had T1 stage KS. Patients with T0 KS had higher CD4 cell counts (P < .001); 90% of patients with T0 KS who were not receiving cART and 84% of those with T1 KS were treated in accordance with the stage-stratified approach. Median follow-up was 4.6 years, and 5-year overall survival was 89%; 54 patients have died, 15 as a result of KS. Overall 5-year survival was 92% for T0 KS and 83% to T1 KS (P = .0024). On-treatment analysis of 213 cART-naive patients with T0 KS treated with cART alone revealed 5-year overall survival of 95% and progression-free survival of 77%. For 140 patients with T1 disease treated with cART and liposomal anthracycline chemotherapy, 5-year overall survival was 85%.
  
  
  CONCLUSIONS
  This stage-stratified approach to the management of KS achieves high survival in patients with advanced KS and reduces exposure to chemotherapy in patients with early-stage KS.
authors.affiliation: All authors: Chelsea and Westminster Hospital, London, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Bower
authors.forename: Alessia
authors.initials: A
authors.lastname: Dalla Pria
authors.forename: Chris
authors.initials: C
authors.lastname: Coyle
authors.forename: Eileen
authors.initials: E
authors.lastname: Andrews
authors.forename: Victoria
authors.initials: V
authors.lastname: Tittle
authors.forename: Sharanjit
authors.initials: S
authors.lastname: Dhoot
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018943:Anthracyclines / Q000008:administration & dosage / Q000627:therapeutic use*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008081:Liposomes; D008297:Male; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D059039:Standard of Care; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D019380:Anti-HIV Agents; D000903:Antibiotics, Antineoplastic; D008081:Liposomes