Treatment of AIDS-associated Kaposi's sarcoma in Zimbabwe: Results of a randomized quality of life focused clinical trial

Abstract

Kaposi's sarcoma is currently the most common tumor in Zimbabwe. The purpose of our study is to compare the effectiveness of supportive care vs. 3 intervention approaches, namely oral Etoposide, a 3-drug combination, and radiotherapy using quality of life (QOL) as the primary measure of success. In addition, our study was to determine whether a disease-specific module has greater sensitivity to group differences than a generic QOL questionnaire and to determine the most pragmatic approach to treating epidemic Kaposi's sarcoma (EKS) in Zimbabwe. In addition, on the physical and psychological subscales, the Etoposide group had a significantly better QOL than the other 3 treatment groups (p < 0.04). The 3-drug combination, supportive care and radiotherapy groups did not differ significantly from each other with respect to the total FLI-C score or its subscales. There were no group differences with respect to survival. Oral Etoposide therapy resulted in better total FLI-C QOL score than radiotherapy. As well, Etoposide resulted in better physical and psychological subscale scores than radiotherapy, 3-drugs and supportive care. Thus, funds permitting, oral Etoposide is a pragmatic approach to treating EKS in an environment where antiretroviral drugs are not universally available. The study underscores the value of undertaking studies in areas of disease prevalence and the necessity of selecting appropriate outcome measures.

Treatment of severe or progressive Kaposi's sarcoma in HIV-infected adults

“…Of the nine included studies, seven had participants with a mix of T0 and T1 Kaposi's sarcoma (Bower 2009; Cianfrocca 2010; Cooley 2007; Hernandez 1997; Martin-Carbonero 2004; Mosam 2012; Olweny 2005). Two studies had only T1 disease patients (Gill 1996; Grünaug 1998).…”

“…Cooley 2007 included 46 patients with T1 disease out of a total of 79 patients. Olweny 2005 included a total of 470 antiretroviral therapy (ART)-naive patients, of which 376 had T1 Kaposi's sarcoma. Martin-Carbonero 2004 included 10 patients with T1 disease out of a total of 28 HIV-infected patients with moderate to advanced Kaposi's sarcoma.…”

“…There were a total of 227 participants, with 116 in the liposomal daunorubicin group and 111 in the ABV group. Olweny 2005 was a four-arm trial that compared supportive care versus supportive care plus oral etoposide, ABV and radiotherapy. There were a total of 378 ART-naive T1 Kaposi's sarcoma patients, of which 178 were in the oral etoposide (90 patients) and ABV (88 patients) groups.…”

Therapeutic strategies for epidemic Kaposi's sarcoma

“…Recently, Olweny et al 45 compared the effectiveness of supportive care with three intervention approaches in Zimbabwe, namely oral etoposide (100 mg daily for five days, repeated monthly), a three-drug combination of actinomycin-D, vincristine and bleomycin, and radiotherapy using quality of life (QOL) as the primary measure of success. HAART was not used in this study.…”

Genetic diversity of the Kaposi's sarcoma herpesvirus K1 protein in AIDS-KS in Zimbabwe

“…Zimbabweans with AIDS-KS typically have advanced HIV-1 disease, KSHV viremia, high tumor burdens, and short survival (Campbell et al, 2003;Olweny et al, 2005). Much of what is known about K1 diversity in African populations comes from studies of persons with KS in East and Central Africa (Zong et al, 1999;Zong et al, 2002;Lacoste et al, 2000).…”