Combination chemotherapy in endemic African Kaposis sarcoma

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We found a series of three small randomised comparative studies of chemotherapy in Ugandan patients with endemic (African) KS.71-73 Chemotherapy is an important modality of treatment for endemic KS in developing countries without adequate access to radiotherapy facilities. On the basis of a previous small randomised study which found a higher response rate for actinomycin D than cyclophosphamide in patients with endemic (African) KS, a second randomised study compared actinomycin D with a combination of actinomycin D plus vincristine.71,72 Twelve patients received actinomycin D alone, 0-42 mg/m2/day for 5 days every 3-4 weeks, and 14 received this with vincristine, 1-4 mg/m2/week until the end of the second course of actinomycin D then on days 1 and 5 of each subsequent course.72 Twenty-four patients were evaluable for response. Two of the 12 patients who received actinomycin D alone died during the first cycle of chemotherapy (Gram-negative sepsis and adrenal failure). A further patient in the combination group developed sepsis after cycle three and died. Complete response was defined as the complete disappearance of all visible/measurable disease, and a partial response as >50% regression of disease. After 4-6 courses of chemotherapy, 13 of 14 patients who received actinomycin D plus vincristine had a complete or partial response, compared with nine of 12 patients randomised to receive actinomycin D alone. However the number of patients in this study is very small and more patients in the combination group had florid type KS or bone lesions.

A further randomised study compared actinomycin D plus vincristine (same schedule as above) with or without the addition of DTIC (dacarbazine), 250 mg/m2 for 5 days with alternate courses of actinomycin D.73

Randomisation was achieved using random cards. The overall response rate for the 40 patients randomised to the two-drug arm was 88%. Of 32 patients randomised to receive the three-drug combination, 30 patients had a complete response (94%), with a further patient having a partial response (overall response rate 97%). Time to best response was quicker for the three-drug combination than the two-drug combination (2 courses versus 5-6 courses).

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