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patients with 179 treated index lesions and 119 control lesions received at least 12 weeks of therapy (or had withdrawn prior to 12 weeks).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.