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Stage stratification benefited patients with Kaposi’s sarcoma
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A stage-stratified approach for the management of AIDS-related Kaposi’s sarcoma improved survival in patients with advanced-stage disease and decreased exposure to chemotherapy among patients with early-stage disease, according to study results.
The study included 469 patients with HIV and Kaposi’s sarcoma.
The stage-stratified approach stipulated that early-stage patients (n=303) receive combination antiretroviral therapy (ART) alone, and advanced-stage patients (n=166) receive combination ART plus liposomal anthracycline chemotherapy.
Among the early-stage patients, 237 had not received combination ART before the study.
Patients with early-stage Kaposi’s sarcoma had higher CD4 cell counts than those with advanced-stage disease (P<.001).
Overall, 90% of patients with early-stage disease who did not previously receive ART and 84% of patients with advanced-stage disease were treated according to the study’s stage-stratified approach.
Median follow-up was 4.6 years.
The overall 5-year OS was 89%. Fifty-four deaths occurred during the study period, 15 of which were due to Kaposi’s sarcoma.
Five-year OS was significantly higher in patients with early-stage disease than those with advanced-stage disease (92% vs. 83%; P=.0024).
Among 213 early-stage patients who were naive to treatment with combination ART, 5-year OS was 95% and PFS was 77%.
Among 140 advanced-stage patients treated according to the study approach, 5-year OS was 85%.
Justin Stebbing
“Although the ability to deliver combination antiretroviral therapy globally is now well established, the present challenge will be to ensure that chemotherapy, and in particular pegylated liposomal doxorubicin, can also be delivered to the same population in an affordable manner,” Jonathan Krell, MD, and Justin Stebbing, MD, PhD, of Imperial College London, wrote in an accompanying editorial. “The delivery of pegylated liposomal doxorubicin as a standard therapy for T1-stage Kaposi’s sarcoma will challenge budgets and distribution networks in many parts of the developing world, not only because of the cost of the drug itself but also because of issues with the cost of sterile reconstitution and delivery in resource-poor settings.”
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Disclosure: The researchers report no relevant financial disclosures.