A Retrospective Analysis of Thalidomide Therapy in Non-HIV-Related Kaposi’s Sarcoma

Abstract

Background: Thalidomide has antiangiogenic and immunomodulatory properties and has recently been used in the management of human malignancies. Several studies have suggested its interest for treating AIDS-related Kaposi’s sarcoma. Objectives: This study aimed to assess the efficacy and toxicity of thalidomide, an antiangiogenic agent, for the treatment of non-HIV-related Kaposi’s sarcoma. Methods: Eleven patients were included in this retrospective study conducted in the Department of Dermatology of Saint Louis, Paris, between 2000 and 2003. Among them, 2 were immunosuppressed (1 renal transplant recipient and 1 patient with microscopic polyangiitis treated by oral steroids) with stable immunosuppressive regimens during the past 6 months. The median daily thalidomide dosage was 100 mg and the median duration of drug treatment was 16 weeks. Results: Three patients achieved a partial response and 4 had a stable disease. Although no grade 3 or 4 was observed, 3 (27%) out of 11 patients prematurely discontinued thalidomide because of grade 1 sensory neuropathy (paresthesia) and vertigo. Conclusions: Our results show a true although modest interest of thalidomide in non-HIV-related Kaposi’s sarcoma and prompt us to evaluate less toxic thalidomide analogues for this indication.

Thalidomide in Kaposi Sarcoma: Promising or Disappointing?

“…Out of these 14 patients, 4 (28%) discontinued thalidomide for side-effects. The overall response rate appears thus to be quite similar in KS, whether HIV associated or not, and lower than the response rates obtained with other systemic therapies such as interferon, pegylated liposomal doxorubicin [10] or even radiotherapy in localized cases [11] .…”

“…retrospective studies [9,10] . In the first study, Rubegni et al [9] treated 3 patients with 100 mg/day of thalidomide for 1 year and observed a complete response in 2 patients (including an immunosuppressed patient with systemic KS) and a partial response in the third.…”

“…In the two responding cases, they observed a negativation of the HHV-8 viral load in the skin and the blood. In the second study [10] , 11 patients were treated with a median dose of 100 mg/day for a median time of 3 months. The results are less impressive, with only 3 patients (27%) achieving a partial response.…”

“…However, an anti-angiogenic approach may still be interesting in KS, as suggested by Ben M'barek et al [10] . With the 'rediscovery' of thalidomide, several structural analogues have been developed in an attempt to find compounds with thalidomide's properties without the associated side-effects.…”

Update on classic Kaposi sarcoma therapy: New look at an old disease

“…Three patients achieved a PR and 4 had SD. Three of 11 patients (27%) prematurely discontinued thalidomide because of grade 1 sensory neuropathy and vertigo [28].…”