Topical treatments for Kaposi sarcoma: A systematic review

Abstract

Background While treatment options exist for solitary or disseminated Kaposi sarcoma (KS) disease, there are currently no standardized clinical treatment guidelines for cutaneous KS. Objective This systematic review seeks to identify safe and effective topical treatments for cutaneous KS lesions. Methods We conducted a systematic review using peer‐reviewed articles from January 1970 to September 2021 published in the PubMed/MEDLINE and EMBASE databases. Results From the initial search that yielded 590 studies, 34 met the inclusion criteria and were selected. Of the 34 studies, seven were clinical trials, 26 were case reports/series and one was a multicentre study. A total of 634 patients were included in our review. The three most common topical treatments used for cutaneous KS were imiquimod, alitretinoin and timolol. Topical alitretinoin was used in three case reports and three clinical trials. Topical imiquimod was used in eight case reports, one prospective phase II cohort study and one comparative single‐blinded non‐controlled clinical study. Topical timolol was used in nine case reports/series. Our review also identified reports of less widely used topical treatments for cutaneous KS. These include topical diphencyprone (DPCP), all‐ trans ‐retinoic‐acid, rapamycin and bleomycin‐dimethylsulfoxide (BLM‐DMSO) which achieved variable response rates but have not been widely studied. Conclusion Topical alitretinoin, imiquimod and timolol demonstrated positive responses for cutaneous KS and the treatments were well tolerated. These three topical treatment modalities could be considered by clinicians when treating cutaneous KS.

Efficacy of immunotherapy with combination of cryotherapy and topical imiquimod for treatment of Kaposi sarcoma

“…In comparison, previous studies found that topical imiquimod alone leads to CR in 34.6% of patients ( n = 26), 5 while cryotherapy alone leads to CR in 63% ( n = 30) 6 . Other common topical therapies included topical alitretinoin and topical timolol, with which 1.5% ( n = 197) and 61.5% ( n = 13) of patients had CR, respectively 4,7–9 . Flow cytometry analyses of classic KS samples ( n = 5) showed 73% of activated CD8 + and 13% of activated CD4 + T cells.…”

“…3 For cutaneous lesions, common topical treatments are timolol, imiquimod, and alitretinoin. 4 After Institutional Review Board approval (protocols 16-458 and 06-107), our institutional database was searched for patients with International Classification of Disease 9 (176.9) or 10 (C46.0) codes for KS seen by a dermatologist with experience in KS management from July 1, 2004 to January 1, 2022. Patient charts were screened to include patients who received combination therapy of cryotherapy followed by topical imiquimod three times a week for 2 months, for a final inclusion of nine patients.…”

“…While KS treatment can depend on a patient's variant type, comorbidities, and level of involvement, multiple treatment modalities have been reported, including chemotherapy, radiation therapy, surgical excision, electrochemotherapy, and cryotherapy 3 . For cutaneous lesions, common topical treatments are timolol, imiquimod, and alitretinoin 4 …”

Kaposi Sarcoma of the Nail Unit: A Case Report and Review of the Literature

“…For localized disease, abstention, radiotherapy, topical gels (alitretinoin, imiquimod, and timolol), intralesional injections (vinblastine or bleomycin), surgery, or cryotherapy are possible ways of therapy [12]. Systemic treatments with antiproliferative agents (taxanes and liposomal anthracyclines or interferon alpha-2b) are generally indicated in the event of visceral or severe and symptomatic cutaneous involvement.…”

Retinoids in cancer chemoprevention and therapy: Meta-analysis of randomized controlled trials

“…This remarkably high response rate of this RCT study may be the main cause of heterogeneity in clinical response. We searched more studies to clarify this problem and found that an approximate clinical response rate of alitretinoin was shown in a recent systematic review comprising three clinical trials and three case reports ( Htet et al, 2022 ). Besides, alitretinoin is Food and Drug Administration-approved medication for Kaposi sarcoma.…”