SIGNIFICANT REGRESSION OF KAPOSPS SARCOMA FOLLOWING INITIATION OF AN EFFECTIVE ANTIRETROVIRAL COMBINATION TREATMENT

Abstract

Background: Anecdotal case reports of regression of Kaposi's Sarcoma(KS) lesions with Zidovudine monotherapy were reported several years ago, but this response was infrequent and transient. Very limited data exists on the role of combination therapy in the treatment of KS lesions. The objective of this report is to describe cases of KS regression following initiation of an effective antiretroviral combination therapy and to correlate CD4 count changes with KS regression. Methods: Retrospective chart review of 6 patients presenting with major improvement of biopsy proven KS lesions. The assessment of KS lesions was based on criteria defined by the ACTG (Krown SE, J Clin Oncol 1989;7 (9):1201-07). All patients were male homosexuals with a mean age of 41 years and an average CD4+ cell count of 52/mm3(range: 10-181/mm3). Four patients had a previous OI and the average delay between initial diagnosis of KS and initiation of the effective combination therapy was 19 months (9 to 51 months). Four patients changed from dual nucleoside analogues to triple combination therapy(2 nucleoside analogues +1 anti-protease). Two patients were antiretroviral naive before starting AZT+3TC. KS lesions were limited to the skin in 4 patients; skin and mucosal involvement were present in 2 patients. In one patient HHV8 load (qPCR) was measured prior to and after antiretroviral treatment. Results: Regression of KS lesions were observed after a mean delay of 6 weeks after initiating therapy. For patients (pts.) with KS limited to the skin, macular lesions (3 pts.) disappeared and nodular lesions (1 pt.) became flat and pale. Two patients who initially responded to IV chemotherapy progressed thereafter (patient #1: bleomycine+ vincristine(VCN) × 7 cycles; patient 2: bleomycine + VCN × 14 cycles then doxorubicine + VCN × 4 cycles). Six weeks after initiating triple combination antiretroviral therapy, patient #1(pulmonary KS) was no longer symptomatic and his skin tumours regressed significantly. Patient#2 presented with a complete clinical remission of his lesions (penis, skin, sclera). For the 6 patients the mean increase of CD4+ cell count is 117/mm3(range: 60-173/mm3) after 8 weeks of combination therapy and all patients had increased weight and improved Karnofsky score. Conclusions: KS regression is observed following significant increase in CD4+ cell count in association with dual- or triple-combination regimens including patients receiving IV chemotherapy. As previously described in organ transplant patients, improvement of immune function may result in KS regression. A prospective study of the role of new combination therapy with clinical and pathological KS evaluation and HHV8 load measurement is warranted.