COMBINATION CHEMOTHERAPY WITH DOXORUBICIN, BLEOMYCIN, AND VINDESINE FOR AIDS-RELATED KAPOSIS-SARCOMA

BACKGROUND. Kaposi's sarcoma is the most common neoplasm in patients w ith human immunodeficiency virus (HIV) infection. Although the best th erapeutic approach is still unclear, patients with advanced KS are usu ally treated with systemic chemotherapy. METHODS. A prospective multii nstitutional Italian study evaluated the efficacy and toxicity of comb ination chemotherapy with doxorubicin, bleomycin, and vindesine (ABVi) in patients with progressive and extensive HIV-related KS. Patients w ere given doxorubicin, 20 mg/m(2) on Day 1; bleomycin, 15 mg on Day 1, and vindesine, 4 mg on Day 1 biweekly +/- granulocyte-colony stimulat ing factor.RESULTS. Overall, 21 of 38 evaluable patients (55%) achieve d an objective response (OR): there was 1 complete response and 20 par tial responses. The most important bone marrow toxicity was granulocyt openia in 61% of the evaluable patients; 34% had Grades 3-4 toxicity, according to the World Health Organization Classification. The majorit y of patients (64%) developed some type of opportunistic infection (OI ) during chemotherapy or the follow-up, with cytomegalovirus infection being the most frequent OI observed. The median duration of survival from KS diagnosis and from the start of ABVi therapy was 19 months (ra nge, 3.4-88.5 months) and 9.9 months (range, 0.1-42.4 months), respect ively. CONCLUSIONS. The high rate of OI during ABVi chemotherapy and t he follow-up is of concern, although these infections possibly could b e due to our patients' low CD4+ lymphocyte counts. However, no toxic d eath was observed in our patients, suggesting that ABVi could be used in patients with aggressive disease, especially those who were previou sly untreated. (C) 1996 American Cancer Society.