Diagnosis and treatment of Kaposi's sarcoma: European consensus-based interdisciplinary guideline (EDF/EADO/EORTC)

Abstract

Kaposi's sarcoma (KS) is a multifocal neoplasm of lymphatic endothelium-derived cells infected with human herpesvirus 8. Four clinical subtypes are distinguished: the classic, the endemic, the epidemic subtype in HIV positive patients and the iatrogenic subtype. The diagnosis is primarily based on clinical features and confirmation by histology with immunohistochemistry. Cutaneous distribution and severity, mucosal, nodal and visceral involvement depend on the type of KS with in general indolent behaviour and chronic evolution in the classic subtype and the more severe forms in iatrogenic or epidemic subtypes. Management should aim at achieving disease control. For localised lesions, several local therapies have been developed without randomised trial comparisons. Radiotherapy, intralesional chemotherapies and electrochemotherapy have high response rates. Topical treatmentsdimiquimod or topical 9-cis-retinoid aciddcan also be used. Systemic treatments are reserved for locally aggressive extensive and disseminated KS: the recommended first-line agents are pegylated liposomal doxorubicin (PLD) and paclitaxel. In CKS, PLD or low-dose interferon-alfa are the recommended first-line agents in younger patients. In AIDS-related KS, combination antiretroviral therapy is the first treatment option; specific systemic treatment is needed only in case of extensive disease and in the prevention and treatment of immune reconstitution inflammatory syndrome. In post-transplant KS, tapering down immunosuppressive therapy and switching to mammalian target of rapamycin (m-TOR) inhibitors are used. Follow-up schedules for patients with KS disease depend on aggressiveness of the disease.

Cannabidiol for Viral Diseases: Hype or Hope?

“…This is to be welcomed as these pathological conditions affect millions of people globally and offer limited therapeutic options to patients so far. 21,22 Importantly, the observed in vitro effects of CBD occur at concentrations achieved in humans with well-tolerated therapeutic doses of Epidiolex (up to 20 mg per kg of body weight per day), 23 suggesting that these findings might be easily translated into clinics. However, there is evidence that, other cannabinoids such as D 9 -THC may instead enhance infection and replication of KSHV and promote KSHV-induced endothelial transformation.…”

Quadruple Multiple Primary Malignancies: Early Detection of Second Primary Malignancy by Esophagogastroduodenoscopy/Colonoscopy Is Crucial for Patients with Classic Kaposi’s Sarcoma

“…Conversely, European consensus-based interdisciplinary guidelines state that endoscopy is not strongly recommended for patients with CKS [30]. In these guidelines, endoscopy (as well as bronchoscopy and total-body CT) is recommended to be performed just according to symptoms in both staging work-up and follow-up for patients with all types of KS [30]. This raises the question as to why endoscopy does not appear to be important in the examination of patients with CKS.…”

“…This raises the question as to why endoscopy does not appear to be important in the examination of patients with CKS. The following two reasons have been indicated: (i) According to some studies, visceral involvement of CKS was reported to be only <10%, which is apparently less than that of other KS [7,30]. Further, a recent report stated that the follow-up interval for patients with CKS can be every 6-12 months, essentially based on clinical examination [31].…”

“…In fact, Cesarman et al mentions that the early detection of KS and other cancers is beneficial for patients with KS, but these benefits have not been examined in randomized trials [31]. As the recent reports state, the goal of CKS therapy is to manage disease control and preserve quality of life [30,31], and to achieve this goal, life-threatening SPMs should be detected in early stages in patients with CKS. [19] 1999 CKS Stomach 1 [19] 1999 CKS Colon, sigma 5 [19] 1999 CKS Ampulla, anus 6 [19] 1999 CKS Central nervous system 2 [19] 1999 CKS Thyroid 1 [12] 1999 CKS Stomach 3…”

Treatment of cutaneous Kaposi sarcoma with methylaminolevulinate photodynamic therapy: A case series

“…Kaposi sarcoma-associated herpesvirus (KSHV, also known as Human Herpesvirus-8) is always involved in its aetiology via endothelial infection 1. In the cutaneous presentation of KS, topical agents and physical therapies such as surgical removal,3 cryosurgery,4 imiquimod, laser, radiotherapy,5 and intralesional and systemic chemotherapy5 have been used even though for the AIDS-associated variant, the most effective treatment is antiretroviral therapy 5. There are only limited reports in literature of PDT usage for KS 6,7.…”