TREATMENT OF KAPOSIS-SARCOMA - CURRENT GUIDELINES AND FUTURE PERSPECTIVES

Kaposi's sarcoma is the most common malignancy associated with HIV inf ection, and the morbidity and mortality attributable to AIDS-related K aposi's sarcoma (AIDS-KS) may be increasing. No curative therapy is av ailable for AIDS-KS, but palliative therapy can eliminate or reduce co smetically unacceptable lesions, reduce painful or unsightly oedema or lymphadenopathy, shrink, symptomatic oral lesions and relieve symptom s caused by visceral involvement. Strategies currently employed to tre at the various clinical problems encountered in AIDS-KS include single - and multi-agent cytotoxic chemotherapy, treatment with interferon-al pha, radiotherapy, and other local therapies. Current clinical researc h is focusing on use of liposome-encapsulated cytotoxic agents and tre atment with substances that inhibit angiogenesis. Any treatment plan f or AIDS-KS must be flexible and must be based on the patient's overall clinical and immunological status as well as therapeutic goals. Limit ed local disease is usually amenable to treatment with local measures. Extensive, symptomatic AIDS-KS warrants systemic treatment. The respo nse of mucocutaneous lesions to low dose systemic cytotoxic chemothera py is typically excellent. Treatment with interferon-alpha may also be beneficial in this setting. Multi-agent chemotherapeutic regimens are usually reserved for treatment of patients most severely affected by AIDS-KS. It is hoped that liposome-encapsulated cytotoxic chemotherapy and antiangiogenic therapies will prove more effective and less toxic than the treatment strategies currently use.