Kaposiʼs sarcoma in HIV infection treated with vincristine and bleomycin

Gompels, Mark; Hill, A. Ross; Jenkins, Peter; Peters, B; Tomlinson, David R.; Harris, J.R.; Stewart, Simon; Aj, Pinching; Munro, Alan

doi:10.1097/00002030-199210000-00018

Cited by 46 publications

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“…The chemotherapy regimen used in these patients was based on bleomycin (10 U/m 2 ) and vincristine (1.4 mg/m 2 ) [27], and was prescribed by the treating physician (usually for patients with extensive skin lesions and lymphedema and/or gastrointestinal or pulmonary involvement).…”

Section: Methodsmentioning

confidence: 99%

Clinical characteristics, predictors of immune reconstitution inflammatory syndrome and long-term prognosis in patients with Kaposi sarcoma

et al. 2017

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ObjectiveTo investigate the predictive factors for the development of Kaposi sarcoma-related immune reconstitution inflammatory syndrome (KS-IRIS) and long-term prognosis in patients starting combined antiretroviral therapy (cART).MethodsWe studied a retrospective-cohort of consecutive antiretroviral-naïve patients with KS initiating cART from January 2005 to December 2011 and followed through June 2013. KS-IRIS was defined as ≥2 of the following: abrupt increase in number of KS lesions, appearance or exacerbation of lung-opacities or lymphedema, concomitantly with an increase in CD4+ cell-count ≥50 cells/mm3 and a decrease of >1 log in viral-load once started cART. We compared individuals who met KS-IRIS criteria with those that did not and described the long-term follow-up.ResultsWe included 89 patients, 88 males; 35 (39%) developed KS-IRIS at a median of 10 weeks (IQR 4–16). KS-IRIS patients had more pulmonary-involvement (60% vs. 16.6% of patients; p < 0.0001), eight died attributed to pulmonary-KS. Thrombocytopenia <100,000/mm3 at follow-up occurred in 36% of KS-IRIS vs. 4% in non-KS-IRIS patients (p = 0.0002), 45% KS-IRIS patients with thrombocytopenia died, non without KS-IRIS. Chemotherapy (bleomicyn–vincristine) was more frequently prescribed in KS-IRIS patients (88.6% vs. 29.6%) with no differences in outcome; 80% of all patients achieve KS complete remission, 52% of them never received chemotherapy. No difference between groups in the long-term follow-up (mean 52.4 ± 27.4 months) was found, only one patient developed a secondary malignancy (1.12%).ConclusionsLung-involvement was predictive of IRIS development. Thrombocytopenia in KS-IRIS patients at week 12 follow-up after cART initiation was associated with high mortality. Over a third of patients with KS achieve remission without chemotherapy. Individuals that survive the initial period of KS-IRIS adhere to cART had a good long-term prognosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12981-017-0156-9) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Clinical characteristics, predictors of immune reconstitution inflammatory syndrome and long-term prognosis in patients with Kaposi sarcoma

et al. 2017

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“…Cytotoxic chemotherapy is effective in treating patients with KS, although it is palliative 4–11. Cytotoxic agents with antitumor activity against KS include doxorubicin, bleomycin, vincristine,4, 5 and, more recently, liposomal daunorubicin6, 7 and liposomal doxorubicin 7–10. Major responses to liposomal anthracyclines given as first‐line therapy have been reported in 25–46% of patients, lasting 90–175 days 6–10.…”

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confidence: 99%

Multicenter trial of low‐dose paclitaxel in patients with advanced AIDS‐related Kaposi sarcoma

Tulpule

Groopman

Saville

et al. 2002

Cancer

142

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BACKGROUND Treatment options are limited for patients with advanced acquired immunodeficieny syndrome (AIDS)‐related Kaposi sarcoma (AIDS‐KS) whose disease has progressed after receiving therapy with liposomal anthracyclines or combination chemotherapy with doxorubicin (Adriamycin), bleomycin, and vincristine (ABV). This study was performed to assess the safety and efficacy of a novel dose and schedule of paclitaxel in patients with AIDS‐KS who failed to respond to previous systemic chemotherapy. METHODS This was an open‐label, multicenter Phase II study. Eligible patients had advanced AIDS‐KS consisting of at least 25 mucocutaneous lesions, visceral disease, or lymphedema, and had failed to respond to at least one previous systemic chemotherapy regimen. Patients were treated with paclitaxel at a dose of 100 mg/m2 given intravenously over 3 hours, every 2 weeks. Primary efficacy end points were tumor response, time to progression, time to treatment failure, and survival. Quality of life and adverse events were evaluated using the Symptom Distress Scale (SDS) and the World Health Organization Toxicity Criteria, respectively. RESULTS One hundred and seven male patients with advanced AIDS‐KS were enrolled from nine participating sites. The median entry CD4+ lymphocyte count was 41/mm3 (range 0–1139). Previous treatment regimens included ABV in 52, liposomal daunorubicin in 49, and liposomal doxorubicin in 40 patients. Forty‐one patients (38%) received two or more previous chemotherapy regimens. Protease inhibitor use during the study was reported by 82 (77%) patients overall; 47 patients (44%) were receiving a protease inhibitor before study entry. Complete or partial response was documented in 60 patients (56%). The median duration of response was 8.9 months. Major response rate was similar when comparing patients not on a protease inhibitor at the time of response (59%) with patients on a protease inhibitor at time of response (54%). However, protease inhibitor use had a significant impact on survival (P = 0.04). Grade 4 neutropenia was reported in 35% of patients; other life‐threatening side effects were uncommon. Significant improvements were seen in the total quality of life scores measured by the SDS, including significant improvement in KS‐related symptoms such as facial disease, tumor‐associated edema, and pulmonary involvement. CONCLUSION Paclitaxel given every 2 weeks induces major tumor regression in the majority of patients with advanced KS who failed to respond to previous systemic chemotherapy. Paclitaxel is associated with significant improvement in quality of life with acceptable toxicity and should be considered as an effective treatment option for patients with advanced KS. Cancer 2002;95:147–54. © 2002 American Cancer Society. DOI 10.1002/cncr.10634

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“…Other systemic adverse effects of bleomycin such as progressive pulmonary toxicity do not appear to be a significant problem in the dosage regimes used to treat KS [7]. It is uncertain whether the peripheral neuropathy seen with combination regimes of bleomycin and vincristine represents an increase above the background prevalence of HIV neuropathy [8], therefore bleomycin appears to be relatively safe in AIDS patients and is also a favoured agent owing to its relative lack of haematotoxicity [9], which permits the concurrent administration of zidovudine [10].…”

Section: Discussionmentioning

confidence: 99%

Bleomycin‐induced flagellate dermatitis in AIDS patients with Kaposi's sarcoma

Nandwania

Money-Kyrle

Hawkins

et al. 1995

Acad Dermatol Venereol

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Objective To describe and illustrate bleomycin-induced cutaneous toxicity, which may present atypically in AIDS patients with Kaposi's sarcoma.Design and subjects Case note review of all AIDS patients receiving systemic chemotherapy in the preeeding year.Setting Combined oncology and HIV out-patient clinic at the Chelsea and Westminster Hospital in London.Outcome measured Cutaneous toxicity assoeiated with intravenous bleomycin therapy. ResultsWe report three cases of bleomycin-induced flagellate dermatitis with atypical presentation of pruritic skin lesions after relatively low doses of bleomycin.Conclusions Bleomycin usage is increasing as an effective agent in the treatment of AIDS-related Kaposi's sarcoma. Awareness that cytotoxic drugs may produce a range of unusual cutaneous adverse effects in this patient population is important for doctors of all specialities who treat HIV-infected patients. The pathomechanism of flagellate dermatitis is discussed.

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Kaposiʼs sarcoma in HIV infection treated with vincristine and bleomycin

Cited by 46 publications

References 0 publications

Clinical characteristics, predictors of immune reconstitution inflammatory syndrome and long-term prognosis in patients with Kaposi sarcoma

Clinical characteristics, predictors of immune reconstitution inflammatory syndrome and long-term prognosis in patients with Kaposi sarcoma

Multicenter trial of low‐dose paclitaxel in patients with advanced AIDS‐related Kaposi sarcoma

Bleomycin‐induced flagellate dermatitis in AIDS patients with Kaposi's sarcoma

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