VANCOUVER, BC--Discussions of Kaposi's sarcoma at the 11th International
Conference on AIDS included reports on a promising topical treatment,
photodynamic therapy (PDT), a chemotherapy regimen that could
save up to $1,000 per course, and the possibility of prevention
using antiherpes drugs.
A retinoid gel shows promise of becoming the first topical therapy
for Kaposi's sarcoma (KS), said Madeleine Duvic, MD, chief, Dermatology
Section, University of Texas M.D. Anderson Cancer Center.
In a phase I/II clinical trial, the 9-cis-retinoic acid (ALRT
1057, being developed by Ligand Pharmaceuticals Inc., San Diego)
proved safe and well tolerated. And although the trials was not
designed to evaluate efficacy, the researchers found that the
gel produced complete resolution of lesions in 9% of patients
and resolution of at least half of lesions in 23%.
Importantly, responses were seen in patients with a wide range
of CD4 counts, including four patients with counts below 50 cells/mm3.
Dr. Duvic suggested that the retinoid gel may make possible a
form of "patient-controlled, conservative management"
in the early phases of KS.
This multicenter study enrolled 63 patients with biopsy proven,
multiple KS lesions. Patients applied the gel to selected index
lesions one to four times daily. Similar control lesions were
left untreated (but could be treated after 8 to 16 weeks). Forty-three
patients with 179 treated index lesions and 119 control lesions
received at least 12 weeks of therapy (or had withdrawn prior
to 12 weeks).
Responses Hard to Evaluate
Response in KS lesions has been notoriously hard to evaluate because
the area of pigmentation associated with the lesion may not shrink
even though response is demonstrable histopatholog-ically, Dr.
Duvic said. This study used methodology developed by the AIDS
Clinical Trials Group, to evaluate response by measuring area
and elevation of the lesion.