ZURICH Intravenous paclitaxel is the treatment of choice in patients whose AIDS-related Kaposi sarcoma isn't responsive to liposomal anthracyclines, Dr. Erwin Tschachler said at the annual meeting of the European Society for Dermatological Research.
"It's more cytotoxic, has more side effects, but works in a considerable percentage of patients in which other cytotoxic therapies have failed. So it's not a first-line treatment," explained Dr. Tschachler, professor of dermatology at the Medical University of Vienna. For localized Kaposi sarcoma, surgery, cryotherapy, radiation therapy, intralesional cytotoxic agents, photodynamic therapy, and topical retinoids remain good options.
But for rapidly progressive cutaneous or symptomatic visceral disease, liposomal anthracyclines have replaced older combination chemotherapy regimens because they have higher remission rates and are much better tolerated, said Dr. Tschachler.
These liposomal agents and paclitaxelall of which are approved by the Food and Drug Administration for the treatment of AIDS-related Kaposi sarcomaare given with palliative rather than curative intent.
Dr. Tschachler and colleagues typically start treatment with liposomal doxorubicin (Doxil) at 20 mg/m2 IV every 2-3 weeks, although it can be given at up to 40 mg/m2. Remission rates of 38%-92% have been reported. Liposomal daunorubicin (DaunoXome) is slightly less effective. The dosing is 40-60 mg/m2 IV every 2 weeks.
Eventually the Kaposi sarcoma is likely to return despite liposomal anthracycline therapy, which is when it's time to switch to paclitaxel (Taxol), he said. Paclitaxel has double the response rate and twice as long an average duration of remission. The recommended dosing is 135-175 mg/m2 IV given over 3 hours every 3 weeks initially, then 100 mg/m2 every 2 weeks to maintain remission.
Dr. Tschachler reported having no conflicts of interest.