Di Lorenzo Giuseppe, Di Trolio Rossella, Montesarchio Vincenzo, Palmieri Giovanna, Nappa Paola, Delfino Mario, De Placido Sabino, Dezube Bruce J
Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy.
Cancer. 2008 Mar 1;112(5):1147-52. doi: 10.1002/cncr.23264.
Classic Kaposi sarcoma (CKS) is a rare neoplasm that predominantly occurs in elderly subjects and has a variable clinical evolution. The clinical course is usually indolent, but occasionally the neoplasm progresses rapidly and spreads to internal organs, necessitating systemic chemotherapy. Because of the rarity of CKS, the best treatment has not been determined to date. To the authors' knowledge, few data exist regarding the use of pegylated liposomal doxorubicin (PLD) as first-line and second-line treatment in advanced CKS. The current retrospective study investigated the activity and toxicity of PLD in pretreated patients with aggressive, nonvisceral CKS.
Patients were treated with PLD at a dose of 20 mg/m(2) intravenously every 3 weeks until disease progression or the occurrence of intolerable side effects. Objective responses were determined after 3 and 6 cycles; toxicity was assessed every cycle. Secondary endpoints were pain intensity, progression-free survival, and overall survival.
Twenty men with pretreated CKS (median age, 67 years) were treated with PLD. All patients received at least 6 cycles of therapy. Complete and partial responses were observed in 2 patients (10%) and 14 patients (70%), respectively. Neutropenia was the most significant grade 3 hematologic toxicity observed (evaluated according to the National Cancer Institute Common Toxicity Criteria for Adverse Events [version 3.0]), occurring in 20% of patients. Only 1 patient (5%) demonstrated grade 4 neutropenia. Fourteen patients (70%) achieved remission of pain and/or edema after 6 cycles. The median progression-free survival was 9 months (95% confidence interval, 5-13 months). At a median follow-up of 36 months, 15 patients (75%) remained alive.
PLD is associated with an improvement in objective response and pain intensity and is well tolerated as a second-line treatment for CKS.
经典型卡波西肉瘤（CKS）是一种罕见的肿瘤，主要发生于老年患者，临床病程多变。其临床过程通常较为缓慢，但肿瘤偶尔会迅速进展并扩散至内脏器官，需要进行全身化疗。由于CKS罕见，目前尚未确定最佳治疗方案。据作者所知，关于聚乙二醇化脂质体阿霉素（PLD）作为晚期CKS一线和二线治疗的应用数据很少。本项回顾性研究调查了PLD在预处理的侵袭性、非内脏型CKS患者中的活性和毒性。
患者接受PLD治疗，剂量为20mg/m²，每3周静脉注射一次，直至疾病进展或出现无法耐受的副作用。在3个和6个周期后确定客观缓解情况；每个周期评估毒性。次要终点为疼痛强度、无进展生存期和总生存期。
20例经预处理的CKS男性患者（中位年龄67岁）接受了PLD治疗。所有患者至少接受了6个周期的治疗。分别有2例患者（10%）达到完全缓解，14例患者（70%）达到部分缓解。中性粒细胞减少是观察到的最显著的3级血液学毒性（根据美国国立癌症研究所不良事件通用毒性标准[第3.0版]评估），20%的患者出现该毒性。仅1例患者（5%）出现4级中性粒细胞减少。14例患者（70%）在6个周期后疼痛和/或水肿得到缓解。中位无进展生存期为9个月（95%置信区间，5 - 13个月）。中位随访36个月时，15例患者（75%）仍存活。
PLD可改善客观缓解和疼痛强度，作为CKS的二线治疗耐受性良好。
