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Immunotherapy is the use of medicines to stimulate a person's own immune system to recognize and destroy cancer cells more effectively.
The way immunomodulating agents affect the immune system isn’t entirely clear. Three immunomodulating agents can be used to treat Kaposi sarcoma (KS). The first of these drugs to be developed, thalidomide, caused severe birth defects when taken during pregnancy. Because the other immunomodulating agents are related to thalidomide, there’s concern that they could also cause birth defects. That’s why all of these drugs can only be ordered through a special program run by the drug company that makes them.
Because all of these drugs can increase the risk of serious blood clots, they are often given along with aspirin or a blood thinner.
Thalidomide (Thalomid) was first used decades ago as a sedative and as a treatment for morning sickness in pregnant women. When it was found to cause birth defects, it was taken off the market. Later, it became available again as a treatment for multiple myeloma. A few studies show it works in some people with KS that has come back or keeps growing on other drugs.
Side effects of thalidomide can include drowsiness, fatigue, constipation, depression, and nerve damage (neuropathy). The neuropathy can be severe, and might not go away after the drug is stopped.
Pomalidomide (Pomalyst) can be used to treat people with KS who are HIV negative or have AIDS but their cancer is no longer responding to highly active antiretroviral therapy (HAART).
Some common side effects of pomalidomide include low blood counts (red cells, white cells, and platelets) kidney problems, rash, constipation, low phosphate or calcium levels, nausea and diarrhea.
Lenalidomide (Revlimid) might be used in some people with KS that has come back or keeps growing on other drugs.
The most common side effects of lenalidomide are thrombocytopenia (low platelets) and low white blood cell counts. It can also cause painful nerve damage.
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National Cancer Institute Physician Data Query (PDQ): Kaposi sarcoma treatment - Health Professional Version. 01/30/2018. Accessed at https://www.cancer.gov/types/soft-tissue-sarcoma/hp/kaposi-treatment-pdq accessed on March 12, 2018.
National Comprehensive Cancer Network (NCCN)—AIDS-Related Kaposi Sarcoma. V1.2020 (02/12/2020). Accessed 05/21/2020 from https://www.nccn.org/professionals/physician_gls/pdf/kaposi.pdf.
Noy A, Dickson M, Gulick RM, Palefsky J, Rubinstein PG, Steir E. Ch. 65 - Acquired Immunodeficiency Syndrome and Cancer. In: Niederhuber JE. Armitage JO, Kastan MB, Tepper JE. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier; 2014.
U. S. Food and Drug Administration/Drug Approvals and Databases. (05/15/2020). FDA grants accelerated approval to pomalidomide for Kaposi sarcoma. Accessed 05/21/2020 from https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-pomalidomide-kaposi-sarcoma.
Yarchoan R, Uldrick TS, Polizzotto MN, Little RF. Ch. 117 - HIV-associated malignancies. In: DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2015.
Last Revised: May 21, 2020
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