During the past two decades a great deal has been learned about the pathogenesis of Kaposi's sarcoma (KS). Besides the relatively benign form of the classic KS, AIDS-related and iatrogenic KS have been recognized as more aggressive entities of the disease, demanding more effective treatment options.
On the other hand, the etiologic role of KHSV (HHV8), as well as some other factors, such as inflammation and neoangiogenesis, have led to new treatment modalities based on targeting agents. The treatment varies depending on the different types of KS, the extent and the rate of progression of the disease, and the general condition, taking into consideration the fact that many patients with classic KS are elderly people. Besides conventional cytostatic drugs, such as etoposide, bleomycin, adriamycine, the vinca rosea alkaloids and combinations of the above, which are still administered in all types of KS, new forms of more effective but less toxic cytostatic agents have been available during the last decade. The pegylated and liposomal forms of anthracyclines are now used as first-line treatment for AIDS-KS and also, lately, for classic KS. Moreover, some new agents such as the taxanes are currently applied as second-line treatment with promising results.
Radiotherapy remains an effective treatment for non-disseminated classic KS and interferon may also be helpful for slowly progressive disease. Some targeted therapies with MMP inhibitors, and angiogenesis inhibitors are currently under investigation. Lately, sirolimus, an immunosuppressive drug, has been very effective in iatrogenic KS. For small, early and solitary lesions, besides conventional treatment (irradiation, cryotherapy, surgical excision and intralesional injections of interferon and vinca rosea alkaloids), alitretinoin, imiquimod and photodynamic treatment have been currently used with promising results. Further studies will clarify the advantages of those new agents. KS with its variety of clinical types, may be more than any other skin neoplasm the example for treating the patient and not the disease.