AIDS-Related Cutaneous Kaposi's Sarcoma: Failure of Treatment with Human Chorionic Gonadotropin

Abstract

Kaposi’s sarcoma (KS) is the most common neoplasia associated with human immunodeficiency virus (HIV) infection 1. Earlier studies have shown that certain preparations of human chorionic gonadotropin (hCG) can inhibit efficiently the growth of KS cell lines in vitro and in immunodeficient mice 2. Recently, a group of investigators reported that AIDS-related KS can be treated successfully with intralesion 3 or subcutaneous injections of hCG 4. We report that treatment with intramuscular (i.m.) hCG failed in 2 patients with AIDS-related KS, while subsequent treatment with interferon alpha (IFN-α) was successful. Intramuscular hCG was administered to 2 HIV-infected patients, with disseminated KS skin lesions, histologicaly confirmed. Both patients had no visceral involvement or systemic signs or symptoms. The first patient was a 55-year-old homosexual male. He was first diagnosed with HIV infection in 1995, but he denied treatment. In April 1997 he was urgently admitted to our hospital for Pneumocystis carinii pneumonia. At that time he had three KS skin lesions in the chest area, with diameters of 50, 110, and 150 mm respectively. The CD4 count was 25 X 106/l and the viral load was 294,600 copies/ml. In June 1997, while under triple antiretroviral therapy (zidovudine, lamivudine, and indinavir), he developed disseminated KS skin lesions. There were 25 skin lesions located on the trunk, upper and lower extremities, and on the nose, with sizes ranging between 25 and 850 mm. The second patient was a 25-year-old homosexual male. He was first diagnosed with AIDS 2 years ago, when he presented with disseminated KS skin lesions. KS was treated successfully with IFN-α, but the patient denied antiretroviral therapy and was lost to follow-up. In July 1997 he presented again with KS skin lesions located on the chest, abdomen and lower extremities. He had 17 skin lesions with a size from 17 to 1025 mm. The CD4 count was 525 X 106/l and the viral load was 122,300 copies/ml. Combination antiretroviral therapy with zidovudine, lamivudine and indinavir was started. Both patients, after an initial evaluation, measurement and mapping of the lesions, received one i.m. injection of 50,000 IU of hCG daily, for 40 consecutive days. We used the preparation Pregnyl (N.V. Organon Oss, Holland), which contains hCG extracted from the urine of pregnant women. Since hCG is relatively atoxic it was administered at a dose higher than in previous reports. At the end of therapy the lesions were measured and their appearance assessed. Treatment with hCG was well tolerated. The only side effect was slight weight gain. In neither patient did we observe complete tumor regression in any of the initial lesions. Partial regression (i.e. >50% decrease in the surface area) was observed in 3 lesions of the first patient and in one lesion of the second patient. Moreover, the second patient developed four new lesions. After the failure of the hCG therapy the drug was discontinued, and both patients were given the standard treatment of IFN-α subcutaneously, at a dose of 5,000,000 IU daily, for 40 consecutive days. At the end of the treatment, biopsy-confirmed complete REPRINT