Facts on File Encyclopedia of Health and Medicine

ENDOSCOPY can determine whether there are
lesions elsewhere in the body, such as in the gas-
trointestinal tract, when symptoms suggest or the
doctor suspects this is the case.

Treatment Options and Outlook

Treatment depends to some extent on whether
the Kaposi’s sarcoma is AIDS related or transplant
related. In either form, methods to remove or
reduce the lesions for improved comfort and
appearance. Such methods may include

• localized CHEMOTHERAPY (injecting a cytotoxic
  agent directly into the lesion)


• external-beam RADIATION THERAPYthat narrowly
  targets the lesion


• the topical retinoid preparation alitretinoin
  (Panretin) applied to the lesion


• surgery to reduce or excise (cut out) the lesion


• liquid nitrogen or cryotherapy, which freezes
  the lesion

Systemic chemotherapy reduces lesions in
recurrent, widespread, or systemic (involving
internal organs as well as the skin) disease in
AIDS-related Kaposi’s sarcoma, though it is not
usually an option for transplant-related Kaposi’s
sarcoma because the immune system cannot with-
stand the assault. Treatment for Kaposi’s sarcoma
in people who have received organ transplants is
often a delicate balance between suppressing
enough immune function to stave off organ rejec-
tion and preserving enough immune response to
fight INFECTION. Sometimes changing the immuno-
suppressive agent gives the immune system
enough of a boost to fight the lesions, causing
them to retreat or disappear.

SYSTEMIC CHEMOTHERAPY AGENTS TO TREAT AIDS-

RELATED KAPOSI’S SARCOMA

daunorubicin doxorubicin paclitaxel
(DaunoXome) (Doxil) (Taxol)

For most cancers, doctors apply an algorithm of
symptoms and progression that helps determine
effective treatment options and prognosis (poten-
tial for improvement). Kaposi’s sarcoma occurs

nearly always in circumstances of depressed or

suppressed immune system function, skewing the

conventional cancer-staging algorithms. The AIDS

Clinical Trials Group (ACTG) system is the most

commonly used staging algorithm for Kaposi’s sar-

coma associated with AIDS or transplant-related

immunosuppression. The ACTG system assesses

three factors:

• number of lesions


• CD4 cell count, which represents immune sys-
  tem function


• systemic conditions that indicate compromised
  immune function

Each factor receives a rating of zero (good) or

one (poor), reflecting the likelihood for five-year

survival, a standard prognosis marker for cancer.

Kaposi’s sarcoma of the skin is seldom itself fatal,

though the extent of its presence indicates the

immune system cannot protect the body from

infection. Kaposi’s sarcoma of internal organs can

be fatal. This cancer is not curable in AIDS or

active immunosuppressive therapy, so treatment

aims to relieve symptoms.

Risk Factors and Preventive Measures

In the United States, HIV infection is the leading

risk factor for Kaposi’s sarcoma. Methods to

reduce exposure to HIV/AIDS also reduce the risk

for Kaposi’s sarcoma. Most AIDS-related Kaposi’s

sarcoma occurs in men who have sex with men,

leading researchers to postulate that there is a

route of sexual transmission for HHV-8. Safer sex

practices are crucial.

As a result of the growing availability and accept-

ance of organ transplantation, the number of cases

of Kaposi’s sarcoma among transplant recipients is

steadily rising. The risk increases the longer the per-

son receives immunosuppressive therapy. Newer

immunosuppressive agents more selectively target

the immune functions responsible for organ rejec-

tion, leaving other immune functions undisturbed.

See also CANCER TREATMENT OPTIONS AND DECISIONS;

HIV/AIDS PREVENTION; SEXUAL HEALTH; SEXUALLY TRANS-

MITTED DISEASE(STD) PREVENTION; SEXUALLY TRANSMIT-

TED DISEASES(STDS); STAGING AND GRADING OF CANCER;

VIRUS.

Kaposi’s sarcoma 169