Oncologic Treatment of HIV-Associated Kaposi Sarcoma 40 Years on.

The observation in 1981 of the emergence of Kaposi sarcoma (KS) among young men who had sex with men was one of the first harbingers of the HIV epidemic. With advances in HIV care, the incidence of HIV-associated KS (HIV ⁺ KS) has decreased over time in the United States. However, it remains a persistent malignancy among some HIV-infected populations and is one of the most common tumors in sub-Saharan Africa. Because of the relapsing and remitting nature of this cancer, patients with HIV ⁺ KS can experience significant, long-term, morbidity. Patients with severe HIV ⁺ KS may also have concurrent lymphoproliferative syndromes, malignancies, and/or infections that can contribute to mortality. Several chemotherapy agents were explored in clinical trials for HIV ⁺ KS during the early stage of the epidemic. As HIV ⁺ KS emerges with CD4 lymphopenia and immunodysregulation, T-cell-sparing options are important to consider. Here, we explore the pathogenesis of HIV ⁺ KS and the current evidence for immunotherapy and therapies that potentially target KS pathogenesis. This review provides the current landscape of therapies for HIV ⁺ KS and highlights management issues for patients with HIV and cancer.
Competing Interests: Ramya RamaswamiResearch Funding: Celgene (Inst), Genentech (Inst), EMD Serono (Inst), CTI BioPharma Corp (Inst), Merck Serono (Inst) Kathryn LurainResearch Funding: Celgene (Inst), Merck (Inst), EMD Serono (Inst), CTI BioPharma Corp (Inst), Miltenyi Biotec (Inst), Janssen Oncology (Inst) Robert YarchoanResearch Funding: Celgene (Inst), Merck (Inst), Genentech (Inst), CTI BioPharma Corp (Inst), Janssen Research & Development (Inst), EMD Serono (Inst), Bristol Myers Squibb/Celgene (Inst)Patents, Royalties, Other Intellectual Property: Patent related to increase in immune surface markers by pomalidomide, lenalidomide, and related drugs in patients with KSHV-associated diseases, Various patents on vasostatin (I), KSHV vIL-6 (I), internalization of surface markers (I), calreticulin (I), and calreticulin fragments (I), Various patents including patents on anti-HIV therapies and soluble IL-2 receptor; mostly expired, Patents on the treatment of Kaposi sarcoma with IL-12, Patent(s) on the treatment of HIV and hepatitis virus with an antiviral drug and a vaccine to prevent resistance.No other potential conflicts of interest were reported.