title: Kaposi's sarcoma in children: an open randomised trial of vincristine, oral etoposide and a combination of vincristine and bleomycin.
abstract: BACKGROUND
  Kaposi's sarcoma (KS) is a common childhood cancer in places where HIV is endemic and access to antiretroviral therapy (ART) is delayed. Despite this there are no randomised trials to compare and assess chemotherapeutic regimens.
  
  
  METHODS
  An open label, randomised trial comparing intravenous vincristine alone, vincristine and bleomycin and oral etoposide, was carried out in children with Kaposi's sarcoma in the Queen Elizabeth Central Hospital, Blantyre, Malawi. HIV infected children were given ART after 2-3 courses of chemotherapy if they were not already on treatment. Neither HIV nor widespread KS are curable and treatment is aimed at disease reduction and improved quality of life. Tumour reduction was assessed by measuring the size of sentinel KS nodules and quality of life (QoL) by using the Lansky score. Follow up was until death or for one year.
  
  
  RESULTS
  92 children were enrolled of whom 46% were naïve to ART; 10 (11%) were HIV negative. Survival was not influenced by age or gender but was better in the oral etoposide and the vincristine and bleomycin groups. P=0.0045. The group receiving oral etoposide had a better quality of life. Toxicity was not significant, and any drop in haemoglobin or white cell count could have been causally related to HIV infection rather than cytotoxic therapy.
  
  
  CONCLUSIONS
  Oral etoposide is a safe, effective treatment to contain KS and improve QoL which can be achieved without many visits to the hospital and intravenous injections.
authors.affiliation: Queen Elizabeth Central Hospital, Blantyre, Malawi.
authors.forename: George
authors.initials: G
authors.lastname: Chagaluka
authors.affiliation: University of Malawi, Zomba, Malawi.
authors.forename: Christopher
authors.initials: C
authors.lastname: Stanley
authors.affiliation: Queen Elizabeth Central Hospital, Blantyre, Malawi.
authors.forename: Kondwani
authors.initials: K
authors.lastname: Banda
authors.affiliation: Royal Marsden Hospital, London, UK.
authors.forename: Sarita
authors.initials: S
authors.lastname: Depani
authors.affiliation: Queen Elizabeth Central Hospital, Blantyre, Malawi.
authors.forename: Jenala
authors.initials: J
authors.lastname: Nijram'madzi
authors.affiliation: Queen Elizabeth Central Hospital, Blantyre, Malawi; College of Medicine, Blantye, Malawi.
authors.forename: Thembie
authors.initials: T
authors.lastname: Katangwe
authors.affiliation: VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Trijn
authors.initials: T
authors.lastname: Israels
authors.affiliation: The Great Northern Hospital, Newcastle, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Bailey
authors.affiliation: The Malawi Liverpool Wellcome Trust Research Laboratories, College of Medicine, Blantyre, Malawi.
authors.forename: Mavuto
authors.initials: M
authors.lastname: Mukaka
authors.affiliation: Queen Elizabeth Central Hospital, Blantyre, Malawi; College of Medicine, Blantye, Malawi. Electronic address: emmolyneux@gmail.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Molyneux
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D011788:Quality of Life / Q000523:psychology; D012514:Sarcoma, Kaposi / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D044966:Anti-Retroviral Agents; D001761:Bleomycin; D014750:Vincristine; D005047:Etoposide
keywords: Children; Kaposi’s sarcoma; Resource limited settings; Treatment