Abstract
Introduction
Kaposi’s sarcoma (KS) is a common childhood cancer in places where HIV is endemic
and access to antiretroviral therapy (ART) is delayed. Despite this there are no randomised
trials to compare and assess chemotherapeutic regimens.
Method
An open label, randomised trial comparing intravenous vincristine alone, vincristine
and bleomycin and oral etoposide, was carried out in children with Kaposi’s sarcoma
in the Queen Elizabeth Central Hospital, Blantyre, Malawi. HIV infected children were
given ART after 2–3 courses of chemotherapy if they were not already on treatment.
Neither HIV nor widespread KS are curable and treatment is aimed at disease reduction
and improved quality of life. Tumour reduction was assessed by measuring the size
of sentinel KS nodules and quality of life (QoL) by using the Lansky score. Follow
up was until death or for one year.
Findings
92 children were enrolled of whom 46% were naïve to ART; 10 (11%) were HIV negative.
Survival was not influenced by age or gender but was better in the oral etoposide
and the vincristine and bleomycin groups. P = 0.0045. The group receiving oral etoposide had a better quality of life. Toxicity
was not significant, and any drop in haemoglobin or white cell count could have been
causally related to HIV infection rather than cytotoxic therapy.
Conclusion
Oral etoposide is a safe, effective treatment to contain KS and improve QoL which
can be achieved without many visits to the hospital and intravenous injections.
Keywords
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Article info
Publication history
Published online: March 17, 2014
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© 2014 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
