Three year survival among patients with aids-related Kaposi sarcoma treated with chemotherapy and combination antiretroviral therapy at Moi teaching and referral hospital, Kenya

Abstract

Background AIDS-related Kaposi sarcoma (AIDS-KS), a common malignancy in Kenya is associated with high morbidity and mortality. AIDS-KS is treated using bleomycin and vincristine (BV) plus or minus doxorubicin in most low resource settings, with response rates ranging from 24.8 to 87%. Survival in low resource settings has not been well documented. We report the three-year survival in a cohort of seventy patients referred to Moi Teaching and Referral Hospital (MTRH). Methods Study participants are part of a randomized phase IIA trial on the use of gemcitabine compared to bleomycin plus vincristine for the treatment of Kaposi sarcoma after combination antiretroviral therapy (cART) in Western Kenya. All patients were followed for three years in MTRH. Survival was determined by three monthly physical examination and analysed using Kaplan-Meier method, while possible determinants of survival such as baseline characteristics, type of chemotherapy, initial CD4 counts, age at enrolment, gender and early response to chemotherapy were analysed using univariate and multivariate Cox regression. Results Participants were aged between 19 and 70 years with 56% being male. The median CD4 count was 224 cells/μl, median duration of HIV diagnosis was 12.0 months and median duration of KS lesions after histology diagnosis before initiating chemotherapy was 4.8 weeks. At three years, 60 (85.7%) patients were alive. Six of those who died were under treatment with BV while four with gemcitabine. There was no difference in the probability of survival between the patients on either treatment arm (HR = 0.573 [95% C. I 0.143, 2.292; p = 0.4311]). Additionally, the hazard ratio (HR) for response after six weeks, age at enrolment and gender indicated that they were not significant determinants of survival. Patients with normal CD4 cell counts (> = 500/μl), had a HR of 0.401(0.05,3.23; p = 0.391), suggesting better survival. Conclusions Patients with AIDS-KS treated with combined antiretroviral drugs had excellent three-year survival regardless of whether they were treated with BV or gemcitabine as first line therapy. An initial CD4 cell count of > = 500/μl appeared to improve survival while gender, age and early response to chemotherapy were not predictors of survival after three years. Trial registration Number PACTR201510001.

Survival of patients with cancer associated thrombosis at the Uganda Cancer Institute

“…Although our result showed a similarly high 1-year OS in patients with haematological malignancies, the higher 1-year OS in patients with KS and lung cancers should be taken with caution due to the small sample size of both KS (8) and lung cancer (5). Notwithstanding, a recent study in Kenya reported excellent survival in patients with KS [15].…”

Characteristics and Treatment Response of Patients with HIV Associated Kaposi’s Sarcoma in Central Kenya

“…15 A study conducted among 70 patients in Western Kenya, in 2014, looking at 3 year survival outcomes after gemcitabine or bleomycin and vincristine therapy reported survival of 85.7%. 16 In 2019, the Kenya National Cancer Treatment Protocols directed that patients with HIV and KS be initiated on anti-retroviral therapy as well as chemotherapy using pegylated liposomal doxorubicin as first line and paclitaxel as second line. 17 A clinical trial by Krown et al in 2020, which compared progression-free survival (PFS) at 48 weeks among patients on bleomycin and vincristine, or oral etoposide vs paclitaxel found PFS to be much higher with the paclitaxel than with the other agents.…”

Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in Kenya

“…Our work across five African countries found that 45% of KS patients were lost to care by 2 years [3], and, once those patients were tracked, corrected mortality was 54% at 3 years [4]. One year survival after diagnosis of HIVrelated KS in sub-Saharan Africa is estimated to be between 60 and 76%, [4][5][6][7][8] though slightly higher in a tightly monitored randomized controlled trial setting [9]. In contrast, in resource rich settings such as the U.S. and Europe, one year survival is 80-95% [10,11].…”