Abstract
PurposeDespite Kaposi's sarcoma (KS) being the most prevalent AIDS-associated cancer in resource limited settings, optimal treatment options remain unknown. We assessed whether bleomycin/vincristine compared to vincristine monotherapy was associated with improved treatment outcomes for AIDS-associated KS among patients initiating combination antiretroviral therapy (cART) in Malawi.MethodsAll patients initiating cART and chemotherapy for AIDS-related KS were identified from an electronic data system from the HIV Lighthouse Clinic from 2002 to 2011. Treatment responses were compared between patients receiving vincristine monotherapy and vincristine/bleomycin. Binomial regression models were implemented to assess probability of tumor improvement for patients receiving vincristine/bleomycin compared to vincristine monotherapy after a complete cycle of chemotherapy (9–10 months). A chi-squared test was used to compare changes in CD4 count after six months of chemotherapy.ResultsOf 449 patients with AIDS-associated KS on chemotherapy, 94% received vincristine monotherapy and 6% received bleomycin/vincristine. Distribution of treatment outcomes was different: 29% of patients on vincristine experienced tumor improvement compared to 53% of patients on bleomycin/vincristine. Patients receiving bleomycin/vincristine were 2.25 (95% CI: 1.47, 3.44) times as likely to experience tumor improvement as to those on vincristine monotherapy. This value changed little after adjustment for age and baseline CD4 count: 2.46 (95% CI: 1.57, 3.86). Change in CD4 count was similar for patients receiving vincristine monotherapy and bleomycin/vincristine (p = 0.6).ConclusionBleomycin/vincristine for the treatment of AIDS-associated KS was associated with better tumor response compared to vincristine monotherapy without impairing CD4 count recovery. Replication in larger datasets and randomized controlled trials is necessary.
Highlights
Kaposi’s sarcoma (KS) is the most common HIV/AIDS associated malignancy in sub-Saharan Africa [1]
The work is made available under the Creative Commons CC0 public domain dedication
We investigate if bleomycin/vincristine combination chemotherapy is associated with improved tumor outcomes compared to vincristine monotherapy among KS patients on combination antiretroviral therapy (cART) in Lilongwe, Malawi
Summary
Kaposi’s sarcoma (KS) is the most common HIV/AIDS associated malignancy in sub-Saharan Africa [1]. Combination antiretroviral therapy (cART) alone is associated with improved clinical KS response, especially among those with more limited disease [4], chemotherapeutic agents alone or in different combinations may lead to improved KS treatment outcomes [5]. Various chemotherapeutic agents have been used for the treatment of AIDS associated KS as single agents. Liposomal anthracyclines, such as liposomal doxorubicin, have shown good tumor response and tolerability, their relatively high cost make them unaffordable for use in sub Saharan Africa [6]. Vincristine, an inexpensive and immunesparing and chemotherapy agent for KS treatment, has been used in the region with modest KS tumor response [7]
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