Kaposi's sarcoma - Treating Kaposi's sarcoma

The treatment for Kaposi's sarcoma depends on what type you have, your symptoms, how far the cancer has spread and your general health.

Many hospitals use multidisciplinary teams (MDTs) to treat Kaposi's sarcoma. These are teams of specialists who work together to decide the best way to proceed with your treatment.

Deciding on the treatment that's best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you'd like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Treatment plans

Although the treatments used for Kaposi's sarcoma usually differ from person to person, typical treatments for each form of the condition are outlined below.

HIV-related Kaposi's sarcoma

Treatment for Kaposi's sarcoma related to an HIV infection aims to reduce the HIV levels in the blood to allow the immune system to recover. This is so the levels of human herpesvirus 8 (HHV-8) in the blood are reduced so the Kaposi’s sarcoma will not recur. HHV-8 is the virus that causes Kaposi's sarcoma.

If you have HIV-related Kaposi's sarcoma, you will be given a course of combination antiretroviral therapy (cART) to reduce the amount of HIV in the blood to a very low or undetectable level.

As well as cART, you may require treatment with radiotherapy or chemotherapy, depending on the site and extent of the cancer and what symptoms it is causing.

Classic Kaposi's sarcoma

As classic Kaposi's sarcoma spreads slowly, immediate treatment isn't usually required and a policy of "watchful waiting" may be recommended. This means your MDT will delay treatment to see whether any symptoms progress. This is often recommended for older people when it's unlikely the cancer will affect their natural life span.

Radiotherapy is usually used if treatment is required, although small skin lesions may be removed using surgery or cryotherapy.

Endemic African Kaposi's sarcoma

Endemic African Kaposi's sarcoma is usually treated using a combination of radiotherapy and chemotherapy.

Transplant-related Kaposi's sarcoma

Transplant-related Kaposi's sarcoma is usually treated by reducing or stopping your current treatment with immunosuppressants (if possible), or with immunotherapy.

The aim is to strengthen your immune system enough to fight off the human herpesvirus 8 (HHV-8) while ensuring your body doesn't reject the transplanted organ. It may take some time to find the best balance between these two treatment objectives.

If this method is unsuccessful, radiotherapy or chemotherapy may be used.

Treatments used

Some of the different treatments used for the various types of Kaposi's sarcoma are described below.

Surgery

If the lesion is small, it may be removed using surgery. Your specialist will inject a local anaesthetic into the affected area to numb the lesions before they're surgically removed.

Cryotherapy

Some small lesions can be removed using a treatment called cryotherapy. This involves freezing the lesions with liquid nitrogen.

Retinoic acid gel

Another treatment for small lesions is a gel called retinoic acid applied directly to the skin, usually several times a day. Up to half of people treated with retinoic acid experience an improvement in their lesions after a few weeks of starting treatment.

Common side effects of this treatment include mild irritation and redness.

Chemotherapy

Chemotherapy is where powerful medication is used to destroy cancer cells. It's often used if the cancer has spread to more than one area.

The medicines can either be given through a drip into a vein in your arm (intravenously), or as a tablet. If the lesion is small, chemotherapy may be injected directly into it. This is called intralesional chemotherapy.

Chemotherapy can cause some significant side effects, including vomiting, temporary hair loss, tiredness and an increased vulnerability to infection.

To reduce the side effects, a type of treatment called liposomal chemotherapy may be used. In liposomal chemotherapy, the medicines are covered in a fat-based coating called liposome.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells while doing as little harm as possible to healthy cells. It can be very effective in reducing the symptoms of Kaposi's sarcoma affecting the internal organs, such as breathlessness and swelling of the arms and legs, and for Kaposi's sarcoma affecting the soles of the feet.

Possible side effects of radiotherapy include:

• tiredness
• sore skin (particularly for people with advanced HIV infection)
• stiff joints and muscles
• feeling sick (nausea)
• temporary hair loss
• loss of appetite
• loss of libido (decreased interest in sex)
• early menopause in women
• temporary erectile dysfunction (inability to obtain or maintain an erection) in men

Most of these side effects gradually disappear after the course of treatment has been completed.

cART

Combination antiretroviral therapy (cART) involves the use of several different medications called antiretroviral therapy to lower HIV levels in the blood by slowing down the rate at which the virus can multiply.

Read more about treating HIV.

Immunotherapy

In immunotherapy (also known as biological therapy), special antibodies are created in a laboratory that work to change the make-up of cancerous cells so the immune system regards them as foreign objects. The immune system then starts to attack the cells in the same way that it would normally attack an infection.

Interferon alpha is an injected immunotherapy now only used rarely to treat Kaposi's sarcoma because of the many side effects. It's usually given by daily injections into the skin over a number of weeks.

Side effects of interferon alpha are common and can include:

• chills
• high temperature (fever) of 38°C (100.4°F) or above
• loss of appetite
• nausea
• headaches
• tiredness
• aching in the back, joints and muscles

Research into other treatments

Researchers are trying to discover effective treatments that could prevent Kaposi's sarcoma from recurring.

One area of research is into targeted therapies. These are a group of medications designed to target and disrupt the functions of the HHV-8 virus, or enhance the immune response to weaken viral activity. However, there's currently no evidence that any of these therapies work.

See clinical trials for Kaposi's sarcoma to see how you can get involved with research into the condition.