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Chapter 16: HIV-Related Malignancies

Bruce J. Dezube

KAPOSI SARCOMA (KS)

Epidemiology of KS

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Epidemiology of KS
Incidence/100,000
United States
Males: 2.1
Females: 0.11
Africa
Males: 39.3
Females: 21.8

Stage at Presentation in HAART Era (Based on ACTG✫ Modified TIS Staging)
Poor risk: 25%
Good risk: 75%

✫ACTG: AIDS Clinical Trials Group

Deaths caused by AIDS since advent of HAART have decreased by more than 50%

 

Nasti G et al. J Clin Oncol 2003;21:2876–2882

Pathology

  1. All KS is caused by human herpesvirus 8 (HHV-8), also called the Kaposi sarcoma-associated herpesvirus (KSHV), a gamma herpesvirus first identified in 1994

  2. Pathology shows a highly vascular tumor with spindle-shaped cells staining positive for KSHV

 

Moore PS, Chang Y. N Engl J Med 1995;332:1181–1185

Work-up

  1. Biopsy to confirm diagnosis

  2. HIV serology

  3. CD4 and HIV-1 viral load

  4. Assessment of tumor extent:

    • Physical examination of the skin and lymph nodes

    • Chest x-ray

    • Chest CT scan not routinely indicated unless x-ray is abnormal

    • For GI symptoms, work-up as indicated

    • Fecal occult blood testing

 

Di Lorenzo G et al. Lancet Oncol 2007;8:167–176

Staging (Validated ACTG TIS Staging for AIDS-KS)

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Staging (Validated ACTG TIS Staging for AIDS-KS)✫
Good Risk: Stage 0 (Stage 0: All criteria below must be satisfied) Poor Risk: Stage 1 (Stage 1: If any of the criteria are present)
Tumor (T)
Confined to skin and/or lymph nodes

Tumor-associated edema or ulceration

Extensive oral KS

Gastrointestinal KS

KS in other nonnodal viscera
Immune System (I)✫
CD4 cells >150/mm3 CD4 cells <150/mm3
Systemic Illness (S)

  • No history of opportunistic infection or thrush

  • No B symptoms persisting >2 weeks, including

    1. Unexplained fever

    2. Night sweats

    3. >10% involuntary weight loss

    4. Diarrhea

  • Performance status >70 (Karnofsky scale)

  • History of opportunistic infections, thrush, or both

  • B symptoms present

     

     

     

     

  • Performance status <70 (Karnofsky scale)

  • Other HIV-related illness (eg, neurologic disease, lymphoma)

Staging example:

A patient with KS restricted to the skin, CD4 count of 10 cells/mm3, and a history of Pneumocystis jirovecii (formerly, P. carinii) pneumonia would be T0 I1 S1

✫According to the AIDS Clinical Trials Group (ACTG). Staging takes into account tumor extent (T), immune status (I), and systemic illness (S)

 

Notes:

  1. In the HAART era, immune status may not be prognostically predictive. However, in patients with resistant HIV, immune status may be relevant

  2. In the HAART era, poor prognosis is T1S1. All other stages are considered good prognosis

 

Krown SE et al. J Clin Oncol 1997;15:3085–3092

Nasti G et al. J Clin Oncol 2003;21:2876–2882

Expert Opinion

Kaposi sarcoma, as an AIDS-presenting manifestation in antiretroviral therapy (ART) naïve patients, often responds to ART. However, not all patients achieve lesion resolution with ART. In addition to ART, radiotherapy or surgery can be ...

New Treatment Regimens

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