Prospective stage-stratified approach to AIDS-related Kaposi's sarcoma
- PMID: 24378415
- DOI: 10.1200/JCO.2013.51.6757
Prospective stage-stratified approach to AIDS-related Kaposi's sarcoma
Abstract
Purpose: Combination antiretroviral therapy (cART) is standard of care for patients with HIV diagnosed with Kaposi's sarcoma (KS), but the current role of systemic chemotherapy is undefined.
Patients and methods: Since 1998, a prospective stage-stratified approach has been adopted for 469 patients with HIV with KS. Patients with early-stage (T0) KS are treated with cART alone; patients with advanced-stage (T1) KS receive cART plus liposomal anthracycline chemotherapy. Clinical characteristics, overall survival, and KS progression-free survival were analyzed according to stage at presentation and treatment received.
Results: A total of 303 patients presented with T0 stage KS, including 237 who were not receiving cART, and 166 patients had T1 stage KS. Patients with T0 KS had higher CD4 cell counts (P < .001); 90% of patients with T0 KS who were not receiving cART and 84% of those with T1 KS were treated in accordance with the stage-stratified approach. Median follow-up was 4.6 years, and 5-year overall survival was 89%; 54 patients have died, 15 as a result of KS. Overall 5-year survival was 92% for T0 KS and 83% to T1 KS (P = .0024). On-treatment analysis of 213 cART-naive patients with T0 KS treated with cART alone revealed 5-year overall survival of 95% and progression-free survival of 77%. For 140 patients with T1 disease treated with cART and liposomal anthracycline chemotherapy, 5-year overall survival was 85%.
Conclusion: This stage-stratified approach to the management of KS achieves high survival in patients with advanced KS and reduces exposure to chemotherapy in patients with early-stage KS.
Comment in
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Broader implications of a stage-guided stratified therapeutic approach for AIDS-related Kaposi's sarcoma.J Clin Oncol. 2014 Feb 10;32(5):373-5. doi: 10.1200/JCO.2013.53.7126. Epub 2013 Dec 30. J Clin Oncol. 2014. PMID: 24378412 No abstract available.
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Reply to S.E. Krown et al.J Clin Oncol. 2014 Aug 10;32(23):2513-4. doi: 10.1200/JCO.2014.56.3833. Epub 2014 Jul 7. J Clin Oncol. 2014. PMID: 25002719 No abstract available.
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Stage-stratified approach to AIDS-related Kaposi's sarcoma: implications for resource-limited environments.J Clin Oncol. 2014 Aug 10;32(23):2512-3. doi: 10.1200/JCO.2014.55.8999. Epub 2014 Jul 7. J Clin Oncol. 2014. PMID: 25002726 Free PMC article. No abstract available.
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