Medication for Kaposi Sarcoma

Medications are usually prescribed to people with human immunodeficiency virus (HIV) and Kaposi sarcoma if they are considered to be in a “poor risk” category. Poor risk means a person has more extensive cancer, with lesions occurring throughout the mouth or in the gastrointestinal tract or lungs. He or she may also have more extensive lymphedema, a buildup of fluid that causes swelling in the arms and legs. People with HIV and Kaposi sarcoma are also considered to be in a poor risk category if they have levels of CD4—white blood cells that help fight infection—lower than 200 cells per microliter.

“Poor risk” can also apply to people who have bacterial, viral, or fungal infections due to a weakened immune system or symptoms—such as night sweats, fever, weight loss, and diarrhea—suggesting an underlying infection is present.

People with HIV and Kaposi sarcoma in the poor risk category are usually given medications to destroy cancer, along with antiretroviral therapy to boost their immune systems.

Doctors may stop prescribing anticancer medications in people with Kaposi sarcoma after the lesions subside or stop growing. They may restart this treatment if cancerous growths reappear, existing ones worsen, or new ones develop.

Chemotherapy is a group of drugs used to destroy cancer cells throughout the body. NYU Langone doctors usually prescribe a chemotherapy drug called liposomal doxorubicin to people with advanced Kaposi sarcoma.

Liposomal doxorubicin can shrink Kaposi sarcoma lesions and prevent new ones from forming. It may also help to ease the symptoms of lymphedema, which is sometimes associated with advanced Kaposi sarcoma.

The drug is administered through a vein with intravenous (IV) infusion on a treatment schedule called a cycle. The duration and number of cycles may vary, depending on how well the drug is working and how well it is being tolerated. A typical liposomal doxorubicin cycle involves giving the drug once every three weeks. People typically receive six cycles, for a total of six doses.

If liposomal doxorubicin doesn’t help shrink Kaposi sarcoma lesions, your doctor may prescribe other chemotherapy drugs, such as paclitaxel, which is given via IV infusion, or etoposide, given via IV infusion or taken by mouth.

NYU Langone physicians are using several new approaches to manage Kaposi sarcoma. Targeted drugs are designed to destroy cancer cells while sparing healthy tissue, potentially resulting in different or fewer side effects than with chemotherapy.

A variety of targeted drugs are under clinical investigation. Some of these have been shown to be effective in a small number of people treated in clinical trials.

Tyrosine Kinase Inhibitors

The tyrosine kinase inhibitor imatinib targets and blocks proteins found on the surface of cancer cells that signal the cells to grow and divide. Blocking these signals causes Kaposi sarcoma cells to die. Imatinib is taken by mouth.

Mammalian Target of Rapamycin Inhibitors

These targeted drugs block proteins inside the cancer cells that are involved in cell division and growth. Mammalian target of rapamycin inhibitors are either taken by mouth or given through a vein with IV infusion.

Monoclonal Antibodies

Monoclonal antibodies help identify and destroy foreign substances in the body, such as bacteria and viruses. One of these drugs, bevacizumab, has been shown to shrink Kaposi sarcoma tumors in a small number of people. The antibodies disrupt the cancer cells’ ability to produce new blood vessels that feed their growth.

Immunomodulators

These medications affect how the immune system functions. Their manner of doing so is not entirely understood. However, it is known that they can make it difficult for Kaposi sarcoma cells to survive, reproduce, or cause symptoms. Immunomodulators, which include thalidomide, are taken by mouth.

Medications used to manage Kaposi sarcoma may cause a variety side effects, most of which subside after treatment is complete.

Chemotherapy drugs may cause nausea and vomiting, fatigue, loss of appetite, diarrhea, and neuropathy, which is nerve damage that causes tingling in the hands, feet, arms, legs, or other parts of the body.

Imatinib may cause symptoms such as nausea, vomiting, joint pain, and skin rash. Bevacizumab may cause weakness, high blood pressure, bleeding, abdominal pain, nausea, and vomiting. Mammalian target of rapamycin inhibitors are associated with skin rashes, anemia, and fatigue, among other side effects. Immunomodulators such as thalidomide may cause drowsiness, dizziness, fainting, constipation, and neuropathy.

Your doctor may adjust the dose of the medication and use additional medications to address any side effects you are experiencing. Specialists at NYU Langone can offer support services to help you manage the side effects of these therapies.

In clinical trials, new medications are being combined with standard drugs, such as liposomal doxorubicin, in people with Kaposi sarcoma. You and your doctor can discuss whether a clinical trial is right for you.