The Frequency and Clinical Consequences of Disruptions Encountered in the Planned Chemotherapy of AIDS-Related Kaposi's Sarcoma: 12

Epidemic KS is an aggressive AIDS-defining malignancy that now occurs in approximately 9% of people with AIDS. It is associated with significant morbidity, and, when in advanced stages, may cause death. Aggressive therapy is usually poorly tolerated and planned treatment delays are common. The presence of AIDS-related infections complicates the management of the KS. Their development during KS treatment frequently shifts treatment priorities. We evaluated the care of individuals with KS to determine both how often planned treatments were disrupted or discontinued and the clinical impact on the successful treatment of KS.

The records of seventy seven consecutive patients with AIDS-related KS being followed in the Infectious Disease AIDS Oncology Clinic at the DHMC were evaluated for any significant disruption or discontinuation of planned treatments for KS. A significant disruption of treatment was defined as any delay in a scheduled cycle of chemotherapy of more than 2 weeks or repeated delays, 2 or more, of at least 1 week. We also noted the reasons for and clinical consequences of treatment interruption or discontinuation.

All 77 patients have died. Sixty five had skin KS only and of those 27 had visceral sites involved as well. Twelve had visceral sites involved only. Variable chemotherapy regimens were used. Sixty one percent had planned therapy delayed or discontinued. The most common reason was the development of infections (CMV retinitis, 14 cases, PCP, 7 cases, and six cases each of fungal infections and MAI). There were 14 case of severe neutropenia. Other causes were AIDS Dementia, CNS lymphoma, CNS Toxoplasmosis, Wasting Syndrome, and neurologic disorders. It was difficult to maintain planned treatment for KS.

The disruption or discontinuation of planned therapy for AIDS-related KS is common. The emergence of AIDS-related infections, requiring treatment the success of which could potentially be affected by continuing cytotoxic chemotherapy, is the most common reason for the interruption of planned KS treatment. Chemotherapy is also poorly tolerated with neutropenia often developing and contributing to treatment delays. The success of KS treatment is frequently compromised for reasons other than the lack of effectiveness of the chemotherapeutic agents chosen. AIDS patients do not tolerate cytotoxic chemotherapy well. Adjustments in planned treatment, by either delaying scheduled treatment cycles or selecting alternative chemotherapeutic agents in order to lessen marrow toxicity when significant infections have developed, is an extremely common occurrence in the management of KS in AIDS.

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National AIDS Malignancy Conference

Bethesda, Maryland April 28-30, 1997

sponsored by the National Cancer Institute