Photofrin photodynamic therapy for treatment of AIDS-related cutaneous Kaposi's sarcoma

Objective: Kaposi's sarcoma, the most common malignancy in AIDS patients, o ften presents with painful cutaneous lesions that are difficult to treat ef fectively despite a wide variety of therapeutic approaches. We used photody namic therapy in an attempt to provide effective palliative treatment for t his disease, Methods: Photodynamic therapy utilizes the activation by light of a photose nsitizing drug that preferentially accumulates in tumor tissue such as Kapo si's sarcoma. We enrolled 25 patients who received 1.0 mg/kg of Photofrin 4 8 h before exposure to 100-400 J/cm(2) of 630 nm light. Results: Of the 348 lesions treated, 289 were evaluable: 32.5% had complete clinical response, 63.3% had partial clinical response and 4.2% were clini cal failures. There was a strong correlation between response and light dos e: 54% of lesions achieved a complete clinical response at optimum light do se (> 250 J/cm(2)). There was no correlation of response with CD4 cell coun t nor was there a change in CD4 cell count post-treatment. At 400 J/cm(2) f ull field scabbing and necrosis occurred in 90% of the treated fields. Thus , the maximum tolerated dose was determined to be 300 J/cm(2). At light dos es of 250 J/cm(2) and below the toxicities were limited to erythema and ede ma in the treatment field. Forty-three biopsies were taken 0.5 h to 4 month s post-treatment. These showed little change in the B and T cell infiltrate s identified. Kaposi's sarcoma cells disappeared post-treatment in certain lesions. Conclusion: Photofrin is effective palliative: treatment for HIV-associated Kaposi's sarcoma. (C) 1999 Lippincott Williams & Wilkins.