Treatment of Kaposi sarcoma

Children with Kaposi sarcoma have responded to treatment with chemotherapy regimens, including bleomycin, vincristine, and taxanes, although there are no prospective clinical trials. Because Kaposi sarcoma is rare in the pediatric population, there are few evidence-based studies.

Evidence (chemotherapy):

Fifty-six Malawian children aged 3 to 12 years with Kaposi sarcoma were treated with six courses of vincristine, bleomycin, and oral etoposide. This was a high-risk population because 48 of the patients (86%) were HIV positive, 36 of whom (77%) were on antiretroviral therapy (ART).[29][Level of evidence C1]

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Fifty-six Malawian children aged 3 to 12 years with Kaposi sarcoma were treated with six courses of vincristine, bleomycin, and oral etoposide. This was a high-risk population because 48 of the patients (86%) were HIV positive, 36 of whom (77%) were on antiretroviral therapy (ART).[29][Level of evidence C1]

Eighteen patients (32%) had a complete remission.

Fifty-six Malawian children aged 3 to 12 years with Kaposi sarcoma were treated with six courses of vincristine, bleomycin, and oral etoposide. This was a high-risk population because 48 of the patients (86%) were HIV positive, 36 of whom (77%) were on antiretroviral therapy (ART).[29][Level of evidence C1]

At 12 months, the overall survival (OS) rate was 71%, and the event-free survival rate was 50%.

Fifty-six Malawian children aged 3 to 12 years with Kaposi sarcoma were treated with six courses of vincristine, bleomycin, and oral etoposide. This was a high-risk population because 48 of the patients (86%) were HIV positive, 36 of whom (77%) were on antiretroviral therapy (ART).[29][Level of evidence C1]

Quality of life improved in 45 patients (80%).

In one retrospective series, 207 children and adolescents with endemic or HIV-related Kaposi sarcoma were treated with unspecified protocols and ART between 2006 and 2015. The study reported a 7-year OS rate of 37% (76 patients). Of these patients, 62% had complete responses, and 8% had stable partial responses. Four of the patients with complete responses had been treated with ART without chemotherapy.[30][Level of evidence C1]

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Even in adults, the evidence and quality of studies are poor, and it is difficult to recommend particular treatment regimens. Other treatment options have been based on adult studies (refer directly below).

In a systematic review of treatment for classic Kaposi sarcoma, 26 articles published from 1980 to 2010 were reviewed. Articles describing populations at high risk secondary to previous transplant and endemic and epidemic Kaposi sarcoma were excluded.[31] All articles had a minimum of five patients per intervention. A greater than 50% decrease in the size of the lesions or lymphedema was considered a response. The quality of the articles was considered poor, primarily because of lack of uniform staging criteria and variable means of assessing response. The following response rates for systemic treatments were noted:

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Pegylated doxorubicin: 71% to 100%.

Vinca alkaloids: 58% to 90%.

Etoposide: 74% to 76%.

Taxanes: 93% to 100%.

Gemcitabine: 100%.

Vinblastine and bleomycin: 97%.

Interferon alfa-2: 71% to 100%.

For local therapies, the following response rates were reported:

Intralesional vincristine: 62%.

Intralesional interferon alfa-2: 50% to 90%.

Imiquimod: 56%.

Radiation therapy: 63% to 93%.[32-34]

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For more information about the treatment of Kaposi sarcoma in adults, see Kaposi Sarcoma Treatment.

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Kaposi Sarcoma Treatment

Publication references