Scand J Infect Dis. 1997;29(1):3-12. doi: 10.3109/00365549709008656.
KS is the most frequent malignancy in homo/bisexual male AIDS patients, affecting more than 30% of these patients. KS may present itself as a few innocent cutaneous lesions or may show progression resulting in severe morbidity and mortality. Approximately half of the patients may develop severe progressive disease. The prognosis of patients with progressive disease is poor, with a median survival of less than 6 months. There is no cure for AIDS-related KS, but several therapies are available for palliation. The treatment options may be applied locally or systemically. Radiotherapy is efficacious and safe, but only a few lesions may be treated at one time. For severe progressive KS, systemic therapy with various forms of chemotherapy is used. Three regimes in particular have been focused on, namely bleomycin/vincristine (BV), doxorubicin + BV (DBV), or liposomal daunorubicin (LD) administered every 2 weeks. The agents result in a clinically relevant response (in 50-80% of patients) 2-4 weeks after initiation, but few patients have complete remission of the KS (< 10%), and the tumour may relapse after 4-6 months despite continued therapy. BV is less effective but also less toxic compared with the other regimens. Time to response for DBV may be slightly better than for LD, but the overall efficacy of these 2 regimes is similar. LD treatment is associated with significantly fewer episodes of peripheral neuropathy and alopecia than treatment with DBV. Thus, the recommended order of use of chemotherapeutic agents is BV, LD and DBV. Alpha-interferon may have a role in the small percentage of patients with CD4 cell count > 200 mill/L. In conclusion, several therapeutic options are available for palliation of KS. All systemically applied therapies are associated with severe side-effects and the optimal choice of treatment is a careful balance between response and toxicity. The recent discovery of human herpes virus 8 as a putative causative agent for KS and new potent groups of anti-retroviral agents, may lead to the development of more effective treatments of KS.
卡波西肉瘤是同性恋/双性恋男性艾滋病患者中最常见的恶性肿瘤，超过30%的此类患者会受其影响。卡波西肉瘤可能最初表现为一些无害的皮肤病变，也可能会进展，导致严重的发病率和死亡率。约一半的患者可能会发展为严重的进行性疾病。患有进行性疾病的患者预后很差，中位生存期不到6个月。与艾滋病相关的卡波西肉瘤无法治愈，但有几种治疗方法可用于缓解症状。这些治疗方案可以局部应用或全身应用。放射治疗有效且安全，但一次只能治疗少数病变。对于严重的进行性卡波西肉瘤，会使用各种形式的化疗进行全身治疗。特别关注了三种治疗方案，即博来霉素/长春新碱（BV）、阿霉素 + BV（DBV）或每两周给药一次的脂质体柔红霉素（LD）。这些药物在开始治疗2 - 4周后会产生临床相关反应（50 - 80%的患者），但很少有患者的卡波西肉瘤能完全缓解（<10%），并且尽管持续治疗，肿瘤可能在4 - 6个月后复发。与其他治疗方案相比，BV效果较差，但毒性也较小。DBV的起效时间可能比LD略好，但这两种治疗方案的总体疗效相似。与DBV治疗相比，LD治疗导致的周围神经病变和脱发发作明显较少。因此，化疗药物的推荐使用顺序是BV、LD和DBV。α - 干扰素可能对CD4细胞计数>200 /μL的少数患者有作用。总之，有几种治疗方案可用于缓解卡波西肉瘤的症状。所有全身应用的治疗都伴有严重的副作用，最佳的治疗选择是在疗效和毒性之间仔细权衡。最近发现人类疱疹病毒8可能是卡波西肉瘤的致病因子，以及新型强效抗逆转录病毒药物组的出现，可能会带来更有效的卡波西肉瘤治疗方法。
