KS lesions of the skin, because they are not usually life threatening, do not necessarily need to be treated. While a number of good localized therapies exist – that is, therapies applied directly to the skin to treat certain lesions – they are generally not effective in preventing new lesions from occurring. And while systemic therapy – drugs taken by mouth or through an intravenous (IV) line – can both treat existing lesions and prevent new ones from occurring, they can cause serious side effects.
KS lesions in the gut and in the lungs require systemic therapy. Without treatment, these lesions can cause serious illness.
No treatment is 100% effective, 100% of the time. In most studies, only a minority of patients actually sees their KS lesions disappear completely. Some patients may not see their lesions disappear, but may see a dramatic improvement in their size, shape, color, and bulkiness; others may not experience any noticeable changes, but may stop new lesions from developing.
Some of the most common local (topical) therapies include:
Alitretinoin (Panretin™): The only topical treatment actually tested in clinical trials and approved by the Food and Drug Administration (FDA) for skin KS lesions. This gel is applied to lesions three or four times a day and has been shown in studies to be effective.
Cryotherapy: Liquid nitrogen is applied to the lesion. This kills the cells in the lesion and promotes healthy skin cells to grow in its place. Good for small lesions.
Radiation therapy: For lesions that are raised, relatively large, or deep in the skin, radiation-or electron-beam therapy-provides good results. Radiation therapy is often recommended for KS lesions on the penis of the feet, given that other local therapies can be painful when used on these two parts of the body.
Intralesional therapy: Some tumors, such as those inside the mouth, can be treated locally using a small amount of chemotherapy and a hypodermic needle.
Vinblastine (Velban®): a chemotherapy drug usually administered through an IV line, can be injected directly into the lesion.
Some of the most common systemic (IV or oral) therapies include:
Antiretroviral therapy (HAART): Considering the profound impact anti-HIV therapy has on viral load and T-cell counts, many HIV-positive people with KS often see their lesions improve while on therapy. Sometimes the effect is dramatic, other times anti-HIV therapy may prevent new lesions from forming. Antiretroviral therapy is often used in combination with other systemic therapies to enhance effectiveness.
Interferon-alfa (Roferon®-A, Intron® A): This drug mimics a naturally occurring protein in the body. It is active against HIV, helps restore immune function, and has been shown to be an effective treatment for KS. Interferon-alfa can cause side effects and is best used in patients who have relatively high T-cell counts (greater than 200 cells/mm3) before starting therapy.
Liposomal chemotherapy (Doxil® or DaunoXome®): These drugs represent a new form of standard chemotherapy drugs. Each dose of these drugs contains millions of microscopic spheres of fat, each sphere containing the active drug. This increases the amount of drug in the blood, thus increases the amount of drug in each lesion. Some research shows that liposomal chemotherapy is more effective – and less toxic – than standard chemotherapy.
Intralesional therapy: Some tumors, such as those inside the mouth, can be treated locally using a small amount of chemotherapy and a hypodermic needle.
Standard chemotherapy (doxorubicin, vincristine, bleomycin, etoposide, paclitaxel): Several studies have examined these drugs, both used as monotherapy and in combination with each other, and have reported varying degrees of success. Combination therapy – particularly bleomycin in combination with vincristine, with or without doxorubicin – has been shown to be more effective than monotherapy. However, side effects are more common in patients taking two or more chemotherapy drugs at the same time.
Search for news stories about this topic