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New treatments for Kaposi's sarcoma reported at Malignancy Conference
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Although KS is not a true cancer -- it appears instead to be caused by an overgrowth of blood vessels -- it does respond to chemotherapy. In some cases, tumours shrink or even disappear under the effects of chemotherapy. Depending on the stage of illness and the severity of complications caused by KS tumours, there may be various reasons for initiating therapy in patients with KS. The following are reports on experimental treatments of KS reported at the recent Malignancies conference in Bethesda, Maryland.
Panretin capsules and gel for KS
(Study 002, abstract 51 - National Malignancies Conference, April 1998)
Panretin (9-cis-retinoic acid, LGD 1057), is a modified form of vitamin A currently being studied for its anti-KS activity. The drug was originally made in the form of a gel which was applied directly to KS lesions on the skin. However, this method was not practical for people who had extensive lesions, so Panretin has also been made available in capsule form. Like vitamin A, Panretin and Atragen (see below) can block the growth of some tumours.
Although 66 subjects were enrolled in this study, only 38 could be properly evaluated. All subjects were male, 50% of whom had CD4+ counts of 229 cells. Seventy-five per cent of subjects had received prior chemotherapy for KS. Most subjects were also using triple anti-HIV drug therapy. Patients received Panretin at a dose of 60 to 100 mg/square metre of skin each afternoon. Fourteen subjects (37%) saw some of their lesions shrink or fade. Fifteen others had no further growth of lesions, while in 4 other subjects (11%), the lesions grew and/or new ones appeared.
Episodes of severe toxicity reported in the study included headache, temporary hair loss, increased shedding of skin cells and high levels of triglycerides in the blood. The skin problems mentioned above occurred despite the use of vitamin E placed on the skin. A total of 11 subjects left the study because of side effects.
Interestingly, people with “[low CD4+ cell counts]”, many tumours and/or prior exposure to chemotherapy responded to Panretin. Amazingly, 10 subjects were able to tolerate 100 mg/m2 of Panretin for nearly 10 months. Should a larger study confirm these effects of the drug, the manufacturer, Ligand Pharmaceuticals, plans to ask the American Food and Drug Administration for their approval of Panretin capsules in 1999. Meanwhile, preliminary results from a placebo-controlled study of Panretin gel in 134 subjects revealed greater benefit in subjects receiving the drug (37%) compared to those on placebo (7%). This difference was considered highly statistically significant. Ligand Pharmaceuticals plans to seek FDA approval of Panretin gel for the treatment of KS next month.
Atragen for KS (Abstract 53)
Tretinoin is a drug used to treat acne that is applied directly to the face. In the early 1990s, some doctors used the drug to treat KS lesions on some of their patients. In people with many lesions, however, this form of therapy is not practical. Therefore an intravenous form of tretinoin packed into tiny balls of fat was developed and called Atragen.
Researchers reported data on 73 HIV+ subjects (key details on subjects were not provided). Subjects were given one of three doses of Atragen: 60, 90 or 120 mg/square metre of skin, once or three times weekly. Forty-four percent (32 subjects) had some of their lesions shrink, fade or disappear. A positive response to Atragen was most often observed in subjects who received the drug thrice weekly. Commonly reported side effects were headache and dry skin. | 
