Chemo-immunotherapy of advanced AIDS-related Kaposi' sarcoma

Aims and background: Kaposi's sarcoma (KS) is the most common neoplastic co mplication of HIV infection and AIDS. Multiple cytotoxic chemotherapy regim ens have been used with various response rates. We have evaluated the effic acy and toxicity of low-dose chemotherapy in patients with poor-prognosis A IDS-related KS and the role of interferon alpha (IFN-alpha) in complete res ponders. Methods: Twenty-five previously untreated patients with advanced KS receive d bleomycin (BL) 10 mg/m(2) and vinblastine (VB) 6 mg/m(2) on days 1 and 15 every two weeks. After six cycles, patients in complete remission received IFN-alpha (3 million U s.c. 3 times/week) combined with antiretroviral the rapy. All patients were evaluated for toxicity using the World Health Organ ization (WHO) toxicity schedule. Both Eastern Cooperative Oncology Group (E COG) and AIDS Clinical Trials Group (ACTG) response criteria were used to e valuate response and survival. Results: The overall response rate was 84% (95% confidence interval, 51-117 %) with six complete remissions (24%) and 15 partial remissions (60%) by EC OG criteria, and 92% (95% confidence interval: 58-128%) with 17 partial rem issions (68%) by ACTG criteria. The median duration of response on FN-alpha treatment was 4.5 months (range, 2-10). The overall median survival durati on for all 25 patients was 9 months (range, 2-39). Grade 3-4 anemia was obs erved in five patients and grade 3-4 neutropenia in two patients. No other clinically significant (greater than or equal to grade 3) toxicities were o bserved. Conclusions: Combination of BL and VB is effective and well tolerated, even if new therapeutic options are developing. This disease remains a challeng ing problem, so larger studies using the combination of chemotherapy and/or IFN-alpha with antiretroviral treatment are warranted.