Because of the relative rarity of the condition, there are also no good data on the response of patients with KS caused by immunosuppression . African KS appears to respond in a similar way to epidemic KS.
Determining whether a lesion becomes smaller with treatment can be quite difficult. Many patients have multiple lesions that are hard to measure accurately and may not respond in the same way to therapy. Changes in a lesion's shape or color may indicate some effect of treatment but not a significant one. One concern about using very aggressive therapy is that the treatment itself might depress the immune system .
• Velban has been the most studied and used single agent. It is well tolerated when given intravenously weekly.
In epidemic KS, response rates of about 25 percent are obtained, with rare complete responses.
• Oncovin , closely related to Velban, has very different side effects and a slightly lower response rate. Weekly
treatment with both of these drugs combined, at a lower dosage or alternating full dosage on a weekly schedule,
raises the response rate to 40 to 75 percent. Side effects are remarkably low, and some complete responses are
seen.
• Vepesid (etoposide, VP-16), given either orally or intravenously, is an attractive drug because it is well
tolerated. It is difficult to use, however, because of its potential to depress blood counts in people who may
already have marginal blood counts. Where it can be used, it has a high response rate. The same general
comments apply to Adriamycin , which can be used only intravenously.
• Daunomycin is very similar to Adriamycin chemically. When coated with fat (lipid) it appears to concentrate
in and be active in KS lesions. Studies show a 70 percent response rate with low toxicity. The drug is available
in Europe, with Phase III investigational studies being completed in the United States.
