Abstract
Objective: To analyze therapeutic strategies for the management of Kaposi's sarcoma (KS) in HIV-infected patients, considering clinical manifestations, evolution of clinical interventions, importance of health education, and multidisciplinary approaches. Methods: A literature review was conducted in the PubMed database using the descriptors "kaposi", "sarcoma", and "treatment" with the Boolean operator "AND". Clinical trials and randomized clinical trials published between 2018 and 2024 in English or Portuguese were included. Articles addressing other pathologies unrelated to the central theme were excluded. The selection followed these steps: theme definition, establishment of study categories, inclusion/exclusion criteria application, verification and analysis of publications, data organization, and data presentation. Results: A total of 8,048 articles were identified. After filtering by publication period (2018-2024), 1,412 remained; by study type, 38 remained; by free full-text availability, 33 remained. After reading the abstracts and excluding duplicates or articles outside the scope, 20 articles were selected for analysis. Final considerations: KS management requires a personalized and multidisciplinary approach. Immunotherapy and combination therapies are promising. Health education is essential for treatment adherence, and opportunistic infection prophylaxis should be integrated into care, improving quality of life and clinical outcomes.
References
GATAULT MC, et al. Overview of Kaposi's Sarcoma: A Focus on the Pathophysiology and Treatment Options. Current Oncology Reports, 2021; 23(6): 1-11.
DURHAM R, et al. The Role of HIV in the Development of Kaposi's Sarcoma. HIV Medicine, 2020; 21(4): 278-287.
MORAIS J, et al. Clinical Features of Kaposi's Sarcoma: A Comprehensive Review. Journal of Dermatological Treatment, 2019; 30(5): 472-478.
REID R, et al. Clinical Management of Kaposi's Sarcoma in HIV-Infected Patients: A Review. AIDS Research and Human Retroviruses, 2019; 35(10): 892-901.
MALIK M, et al. Advances in the Treatment of Kaposi's Sarcoma: From Chemotherapy to Immunotherapy. The Oncologist, 2020; 25(12): e2101-e2112.
MANOLOPOULOS P, et al. Opportunistic Infections in Patients with Kaposi's Sarcoma: Impact on Survival. Infectious Disease Reports, 2021; 13(1): 27-36.
MALEK F, et al. Immunotherapy in Kaposi's Sarcoma: Current Perspectives and Future Directions. Cancer Treatment Reviews, 2021; 97: 102202.
MILLER R, et al. Combined Therapies for the Treatment of Kaposi's Sarcoma: A Systematic Review. Cancer, 2021; 127(6): 1025-1038.
KARL J, et al. Multidisciplinary Care for Patients with Kaposi's Sarcoma: Importance and Outcomes. Journal of Multidisciplinary Healthcare, 2020; 13: 839-847.
TAVARES J, et al. Health Education in Kaposi's Sarcoma: The Importance of Patient Awareness. Patient Education and Counseling, 2019; 102(9): 1640-1646.
SGADARI C, et al. Clinical Efficacy of the HIV Protease Inhibitor Indinavir in Combination with Chemotherapy for Advanced Classic Kaposi Sarcoma Treatment: A Single-Arm, Phase II Trial in the Elderly. Cancer Res Commun. 2024; 4(8): 2112-2122.
ANIDI IU, et al. Exacerbation of CMV and Nontuberculous Mycobacterial Infections Following PD-1 Blockade for HIV-Associated Kaposi Sarcoma. Open Forum Infect Dis., 2024; 11(5).
RAMON-LUING LA, et al. Valganciclovir modulates the tumor necrosis factor axis molecules expression and CD4+ T-cell subsets in disseminated Kaposi Sarcoma patients. Clin Exp Immunol., 2024; 215(2): 190-201.
RUBINSTEIN PG, et al. Brentuximab vedotin with AVD for stage II-IV HIV-related Hodgkin lymphoma (AMC 085): phase 2 results from an open-label, single arm, multicentre phase 1/2 trial. Lancet Haematol., 2023; 10(8).
HAIGENTZ M Jr, et al. Phase I Trial of the Multi-kinase Inhibitor Cabozantinib, a CYP3A4 Substrate, plus CYP3A4-Interacting Antiretroviral Therapy in People Living with HIV and Cancer (AMC-087). Clin Cancer Res., 2023; 29(24): 5038-5046.
LURAIN K, et al. Immunophenotypic analysis in participants with Kaposi sarcoma following pomalidomide administration. AIDS, 2023; 37(11): 1693-1703.
DORVIL N, et al. Same-day testing with initiation of antiretroviral therapy or tuberculosis treatment versus standard care for persons presenting with tuberculosis symptoms at HIV diagnosis: A randomized open-label trial from Haiti. PLoS Med., 2023; 20(6).
VOLKOW P, et al. Impact of valganciclovir therapy on severe IRIS-Kaposi Sarcoma mortality: An open-label, parallel, randomized controlled trial. PLoS One, 2023; 18(5).
SABOURIN KR, et al. Evaluation of a training intervention to improve cancer care in Zimbabwe: Strategies to Improve Kaposi Sarcoma Outcomes (SIKO), a prospective community-based stepped-wedge cluster randomized trial. J Int AIDS Soc., 2022; 25(8).
ZER A, et al. Phase II single-arm study of nivolumab and ipilimumab (Nivo/Ipi) in previously treated classical Kaposi sarcoma (cKS). Ann Oncol., 2022; 33(7): 720-727.
JI Y, et al. Sirolimus plus prednisolone vs sirolimus monotherapy for kaposiform hemangioendothelioma: a randomized clinical trial. Blood., 2022; 139(11): 1619-1630.
CHANG AY, et al. Compression Therapy for HIV-Associated Kaposi Sarcoma Leg Lymphedema: Results of the Kenyan Improvised Compression for Kaposi Sarcoma Randomized Controlled Trial. JCO Glob Oncol., 2022; 8.
RAMASWAMI R, et al. Safety, Activity, and Long-term Outcomes of Pomalidomide in the Treatment of Kaposi Sarcoma among Individuals with or without HIV Infection. Clin Cancer Res., 2022; 28(5): 840-850.
NYIRENDA M, et al. Early Progression and Immune Reconstitution Inflammatory Syndrome During Treatment of Mild-To-Moderate Kaposi Sarcoma in Sub-Saharan Africa and South America: Incidence, Long-Term Outcomes, and Effects of Early Chemotherapy. J Acquir Immune Defic Syndr., 2020; 84(4): 422-429.
KROWN SE, et al. Treatment of advanced AIDS-associated Kaposi sarcoma in resource-limited settings: a three-arm, open-label, randomised, non-inferiority trial. Lancet, 2020; 395(10231): 1195-1207.
GRUFFAZ M, et al. Signatures of oral microbiome in HIV-infected individuals with oral Kaposi's sarcoma and cell-associated KSHV DNA. PLoS Pathog., 2020; 16(1).
REID EG, et al. Pilot Trial AMC-063: Safety and Efficacy of Bortezomib in AIDS-associated Kaposi Sarcoma. Clin Cancer Res., 2020; 26(3): 558-565.
KANG M, et al. Interim monitoring in a treatment strategy trial with a composite primary endpoint. Contemp Clin Trials, 2019; 86: 105846.
IRIRA M, et al. Prevalence and Outcome of HIV-associated Malignancies Among HIV-infected Children Enrolled into Care at Kilimanjaro Christian Medical Center 2006 to 2014: A Hospital-based Retrospective Analytical Study. J Pediatr Hematol Oncol., 2020; 42(1): 69-73.
SHAIK F, et al. Health-Related Quality of Life in Patients Treated With Antiretroviral Therapy Only Versus Chemotherapy and Antiretroviral Therapy for HIV-Associated Kaposi Sarcoma: A Randomized Control Trial. J Glob Oncol., 2018; 4: 1-9.
