AIDS Malignancy Consortium, c/o The EMMES Corporation, Rockville, Maryland, USA.
Curr Opin Oncol. 2011 Sep;23(5):463-8. doi: 10.1097/CCO.0b013e328349428d.
The purpose of this review is to summarize recent published literature on treatment of AIDS-associated Kaposi sarcoma, the most common HIV-associated malignancy and a leading cancer diagnosis in sub-Saharan Africa (SSA), and to highlight the challenges faced in treating Kaposi sarcoma in this resource-limited environment.
There are few prospective clinical trials for Kaposi sarcoma treatment in SSA, along with a relatively poor cancer treatment infrastructure, leading to late diagnosis and poor access to therapy. The only prospectively randomized trial of chemotherapy compared antiretroviral therapy (HAART) alone to HAART with combination chemotherapy with doxorubicin, bleomycin and vincristine (ABV), and documented a significantly higher rate of tumor regression for the combination along with improvement in quality of life and no adverse effects on HIV control. Other studies suggest that gemcitabine may be an active second-line chemotherapeutic agent after failure of HAART and ABV and suggest that AIDS-associated Kaposi sarcoma in children may respond well to HAART with chemotherapy. There are also (primarily retrospective) data suggesting a beneficial effect of HAART on Kaposi sarcoma, but some evidence for Kaposi sarcoma as a manifestation of immune reconstitution inflammatory syndrome.
Opportunities and need exist for prospective research to establish evidence-based guidelines for the most effective treatments for Kaposi sarcoma in SSA.
本文旨在总结近期发表的关于艾滋病相关卡波西肉瘤（AIDS-associated Kaposi sarcoma，最常见的 HIV 相关恶性肿瘤，也是撒哈拉以南非洲（sub-Saharan Africa，SSA）地区主要的癌症诊断）治疗的文献，重点介绍在资源有限的环境下治疗卡波西肉瘤所面临的挑战。
在 SSA，针对卡波西肉瘤的治疗仅有少数前瞻性临床试验，且癌症治疗基础设施相对较差，导致诊断较晚，治疗机会不足。唯一一项前瞻性随机化疗试验将抗逆转录病毒治疗（HAART）与多柔比星、博来霉素和长春新碱联合化疗（ABV）进行了比较，结果表明联合治疗的肿瘤消退率显著更高，同时生活质量得到改善，对 HIV 控制也无不良影响。其他研究表明，吉西他滨可能是 HAART 和 ABV 治疗失败后的有效二线化疗药物，并表明儿童艾滋病相关卡波西肉瘤可能对包含化疗的 HAART 反应良好。也有（主要为回顾性）数据表明 HAART 对卡波西肉瘤有有益作用，但也有证据表明卡波西肉瘤是免疫重建炎症综合征的一种表现。
在 SSA，有机会和需求进行前瞻性研究，以制定针对卡波西肉瘤最有效治疗方法的循证指南。
