KAPOSIS-SARCOMA AND ITS MANAGEMENT IN AIDS PATIENTS - RECOMMENDATIONSFROM A SCANDINAVIAN STUDY-GROUP

KS is the most frequent malignancy in homo/bisexual male AIDS patients , affecting more than 30% of these patients. KS may present itself as a few innocent cutaneous lesions or may show progression resulting in severe morbidity and mortality. Approximately half of the patients may develop severe progressive disease. The prognosis of patients with pr ogressive disease is poor, with a median survival of less than 6 month s. There is no cure for AIDS-related KS, but several therapies are ava ilable for palliation. The treatment options may be applied locally or systemically. Radiotherapy is efficacious and safe, but only a few le sions may be treated at one time. For severe progressive KS, systemic therapy with various forms of chemotherapy is used. Three regimes in p articular have been focused on, namely bleomycin/vincristine (BV), dox orubicin +BV (DBV), or liposomal daunorubicin (LD) administered every 2 weeks. The agents result in a clinically relevant response (in 50-80 % of patients) 2-4 weeks after initiation, but few patients have compl ete remission of the KS (<10%), and the tumour may relapse after 4-6 m onths despite continued therapy. BV is less effective but also less to xic compared with the other regimens. Time to response for DBV may be slightly better than for LD, but the overall efficacy of these 2 regim es is similar. LD treatment is associated with significantly fewer epi sodes of peripheral neuropathy and alopecia than treatment with DBV. T hus, the recommended order of use of chemotherapeutic agents is BV, LD and DBV, Alpha-interferon may have a role in the small percentage of patients with CD4 cell count >200 mill/L. In conclusion, several thera peutic options are available for palliation of KS. All systemically ap plied therapies are associated with severe side-effects and the optima l choice of treatment is a careful balance between response and toxici ty. The recent discovery of human herpes virus 8 as a putative causati ve agent for KS and new potent groups of anti-retroviral agents, may l ead to the development of more effective treatments of KS.