This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Treatment for KS is more effective than it was a couple of decades ago. Doctors now better understand what causes KS. Many clinical trials have been done to compare different approaches to treatment. Doctors have much more experience with KS than they did when this disease was quite rare. Choices about the best treatment options for each patient are based on the function of the immune system as well as the number, location and size of the KS lesions. The patient’s general condition is also a major factor. The presence and severity of other serious medical conditions can make some treatments a poor choice. Some of the treatments used for KS are surgery, chemotherapy, radiation therapy, and biologic therapy. In some cases, 2 or more of these treatments are used together.

Treating immune deficiency and related infections

The most important treatment for KS is to treat any immune deficiency that exists as well as any related infections. In people with AIDS, this means using combinations of anti-HIV drugs. This is known as highly active antiretroviral therapy (HAART). For many AIDS patients, HAART may be the only treatment needed for the KS. In organ-transplant patients who are immune- suppressed because they are taking medicines, decreasing or changing the drugs may be helpful. New KS lesions are more likely to develop when a patient's blood test results for KS herpesvirus (KSHV) are positive. The risk of developing new lesions is lower when antiviral medicines such as ganciclovir or foscarnet are used. These medicines may help prevent new lesions, but do not help existing lesions get better. KS lesions tend to get worse when patients develop infections with bacteria. Therefore, it is very important to take measures to prevent bacterial infections and to treat them promptly and effectively if they do occur.

Local therapy

Local treatment is something that is used to treat only certain lesions (or areas of lesions). This type of treatment is often used to treat some skin lesions to help the patient look or feel better. It is most useful when there are just a few lesions that are in a very visible area (such as the face). The drawback of local therapy is that it doesn't keep new lesions from developing.

One form of local therapy is called topical treatment. This involves putting medicine directly on the lesion. Alitretinoin, a substance related to vitamin A, is available as a gel (Panretin^®) that can be used to treat KS skin lesions. When it is placed on a KS lesion 2 to 4 times a day, it causes it to get smaller or go away in 1 to 2 months. Side effects of this gel include skin irritation and lightening of the skin.

Another type of local treatment is cryosurgery. In this procedure a probe cooled with liquid nitrogen is used to freeze the lesions. This has a good success rate.

Another approach is called intralesional chemotherapy. A small amount of a chemotherapy drug is injected directly into the KS lesions. Only a small amount of the drug is needed and very little is absorbed into the body. This allows the patient to avoid many of the side effects normally seen with chemotherapy. The most common drug used for intralesional chemotherapy in KS is called vinblastine. In the past, an immune-stimulating drug called interferon was used for these injections, but it is rarely used now. Sodium tetradecyl sulfate (STS or Sotradecol^®) is another drug used for intralesional chemotherapy of KS.

Photodynamic treatment is also an option. The patient is given a drug that builds up more in tumor cells than in normal skin. About 48 hours after giving the drug, light is used to activate the drug, which kills the cells.

Radiation therapy

Radiation therapy uses high-energy radiation to kill cancer cells. When the radiation is delivered from outside the body it is called external beam radiation therapy. This is the type of radiation therapy most often used to treat lesions of KS.

Radiation therapy is often used as a local therapy to treat KS when the disease is only in a few areas. Radiation treatments are used to reduce symptoms like pain or swelling. It is also used for skin lesions that look bad and are in an area that can easily be seen (like the face). The form of radiation often used to treat the skin is called electron-beam radiation therapy (EBRT). It uses tiny particles called electrons that don't penetrate far past the skin's surface. This lessens non-skin side effects. EBRT can also be used to treat a large area if the patient has many, widespread KS lesions.

Radiation can also be used to treat KS lesions in the mouth or throat. The form of radiation used for this is known as photon radiation.

Side effects of radiation therapy can include skin changes, nausea, vomiting, and fatigue, Radiation can also cause anemia (low red blood cells), as well as lower numbers of white blood cells, which increases the risk of infection. Serious side effects are rare when radiation is given to just a small area of the skin, but severe skin reactions do occur in about 5% of patients. When radiation is used to treat KS lesions in the mouth or throat, these areas can become painful and open sores can develop. If chemotherapy and radiation are given at the same time, the side effects are worse. For more information on radiation therapy, see our document, Understanding Radiation Therapy: A Guide for Patients and Families.

Surgery

When only a few, small KS lesions are present, they may be removed with surgery.

Chemotherapy

Chemotherapy (chemo) is the use of drugs to treat cancer. When the drugs are given into a vein or by mouth, they enter the bloodstream to reach all areas of the body. This is a type of systemic treatment. It is useful to treat cancer that has spread to many areas of the body. When the drugs are injected directly into a tumor it is called intralesional chemotherapy (see the section, "Local therapy," above).

For systemic chemo the drugs used most often to treat KS belong to a group known as liposomal anthracyclines. Anthracyclines are drugs that are used to treat many different cancers, such as lymphoma and breast cancer. In liposomal anthracyclines, the drugs are enclosed in tiny fat globules. In this form, they are better taken up by tumors and have fewer side effects. They have become the first choice for KS treatment. The 2 liposomal anthracyclines used in the US to treat KS are doxorubicin (Doxil^®) and daunorubicin (DaunoXome^®).

Other chemotherapy drugs that are used to treat KS are paclitaxel (Taxol^®) and vinorelbine (Navelbine^®). Drugs that have been used in the past include bleomycin, vinblastine, vincristine, and etoposide

More than half of KS patients treated with chemotherapy will improve, but KS generally doesn’t go completely away. It is sometimes possible to stop treating the KS as long as lesions are not causing problems or increasing in size and number. If there is evidence that the KS is starting to get worse, treatment can resume. In all patients, it is important to try to improve immune function and treat related infections. This is especially important when giving chemotherapy, which generally decreases the body's ability to fight some infections.

Chemotherapy drugs kill cancer cells but also can damage some normal cells. This happens more often when it is given as a systemic treatment. Your health care team will pay careful attention to avoiding or minimizing side effects. The side effects you experience depend on the type of drugs, the amount taken, and the length of treatment. Common temporary side effects might include:

• nausea and vomiting
• loss of appetite
• loss of hair
• mouth sores
• low blood counts

Because chemotherapy can damage the blood-producing cells of the bone marrow, you may have low blood cell counts. This can result in:

• an increased risk of infection (due to a shortage of white blood cells)
• bleeding or bruising after minor cuts or injuries (due to a shortage of blood platelets)
• fatigue or shortness of breath (due to low red blood cell counts)

Drugs such as vincristine or paclitaxel can damage nerves, sometimes leading to feelings of numbness, particularly in your fingers and toes. This damage can also cause some weakness in your arms and legs. These problems tend to be worse in AIDS patients because the AIDS virus affects bone marrow and often nerve cells.

Some side effects disappear a few days after treatment, but some can last a long time (or even be permanent). Be sure to ask your doctor about the possible side effects from chemotherapy drugs that you will receive. There are good treatments to prevent or reduce many of the temporary side effects of chemotherapy. For example, your doctor can prescribe anti-nausea drugs for you to prevent or reduce nausea and vomiting.

For more information on chemotherapy, see our document, Understanding Chemotherapy: A Guide for Patients and Families.

Biologic therapy

Biologic therapy uses chemicals produced naturally by the body (or forms of these chemicals manufactured in a lab) to help the immune system attack cancer cells. One of the first drugs used to treat KS, interferon alpha, is an example of biologic therapy. For KS, interferon is injected daily. The injection can be directly into a muscle (called IM) or under the skin (called SC). Interferon seems to work by preventing viruses from reproducing and by activating immune system cells that attack and destroy the virus.

Between 25% and 50% of patients with good immunologic function improve when given high doses of these drugs, but patients with fevers, weight loss, or low CD4 counts rarely respond to interferon. The best success rates occur in patients who do not have opportunistic infections and those who have a relatively healthy immune system. It can take 6 months or more to see a response from this treatment.

The most common side effects of interferon therapy are flu-like symptoms (fever, pain, and weakness). Treatment with interferon can also cause low blood counts, liver problems, and confusion. It can take months of treatment with interferon before the KS lesions show improvement. Interferon alpha was one of the first treatments for AIDS-related KS, but is not often used now because of its side effects and because it doesn't work well in many patients with AIDS.

More information on biologic therapy can be found in our document, Immunotherapy.

Last Medical Review: 09/17/2009
Last Revised: 09/17/2009