Clinical activity of lenalidomide in visceral human immunodeficiency virus-related Kaposi sarcoma.

Abstract

IMPORTANCE:

Curative treatment of aggressive Kaposi sarcoma (KS) with conventional chemotherapy in human immunodeficiency virus (HIV)-infected patients remains difficult. The administration of thalidomide, an immunomodulatory drug with antiangiogenic effects, is limited by its toxicity. This engenders interest in evaluating thalidomide analogues such as lenalidomide with better toxicity profiles. To our knowledge, we describe for the first time a patient with visceral KS successfully treated with lenalidomide.

OBSERVATIONS:

A man with advanced visceral HIV-related KS progressing after 11 months of highly active antiretroviral therapy (HAART) and 2 lines of conventional chemotherapy (pegylated liposomal doxorubicin and docetaxel) was treated with lenalidomide on a compassionate use basis. He showed a rapid partial response without any substantial adverse effect but experienced relapse after 5 months of treatment, in a context of virologic failure.

CONCLUSIONS AND RELEVANCE:

Similar to our observation, good partial response without toxic effects has been reported in 3 patients with only skin involvement. Because immune reconstitution syndrome may occur in HIV-infected patients with KS undergoing HAART, KS improvement may be partly explained by immune recovery. An ongoing US phase 1/2 trial will better evaluate the efficacy and tolerance of lenalidomide in patients with HIV-related KS with and without visceral involvement.

• Authors: Maud Steff, Véronique Joly, Julie Di Lucca, Judith Feldman, Samuel Burg, Laure Sarda-Mantel, Gilles Peytavin, Eduardo Marinho, Béatrice Crickx, Eric Raymond, Sylvie Lariven, Eve Maubec
• Journal: JAMA dermatology (JAMA Dermatol) Vol. 149 Issue 11 Pg. 1319-22 (Nov 2013) ISSN: 2168-6084 [Electronic] United States
• PMID: 24080749 (Publication Type: Case Reports, Journal Article)

Chemical References

• Angiogenesis Inhibitors
• Thalidomide
• Lenalidomide

Topics

• AIDS-Related Opportunistic Infections (diagnostic imaging, drug therapy, pathology)
• Angiogenesis Inhibitors (therapeutic use)
• Antiretroviral Therapy, Highly Active
• Black People
• CD4 Lymphocyte Count
• Compassionate Use Trials
• HIV-1 (physiology)
• Humans
• Lenalidomide
• Liver Neoplasms (diagnostic imaging, drug therapy, secondary)
• Lung Neoplasms (diagnostic imaging, drug therapy, secondary)
• Lymphatic Metastasis
• Male
• Middle Aged
• Pancreatic Neoplasms (diagnostic imaging, drug therapy, secondary)
• Sarcoma, Kaposi (diagnostic imaging, drug therapy, pathology)
• Thalidomide (analogs & derivatives, therapeutic use)
• Tomography, Emission-Computed, Single-Photon
• Treatment Outcome
• Viral Load