Treatment strategies for Kaposi sarcoma in sub-Saharan Africa: challenges and opportunities.
Treatment strategies for Kaposi sarcoma in sub-Saharan Africa: challenges and opportunities.
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DOI：
10.1097/cco.0b013e328349428d
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发表时间：
2011-09
影响因子：
3.4
通讯作者：
Krown SE
中科院分区：
文献类型：
--
作者：
Krown SE
这篇综述的目的是总结最近发表的关于艾滋病相关卡波西肉瘤(KS)治疗的文献，KS是撒哈拉以南非洲(SSA)最常见的艾滋病毒相关恶性肿瘤和主要的癌症诊断，并强调在这个资源有限的环境中治疗KS所面临的挑战。在SSA中，KS治疗的预期临床试验很少，加上相对较差的癌症治疗基础设施，导致诊断延迟和难以获得治疗。唯一的前瞻性随机化疗试验将单用抗逆转录病毒疗法(HAART)与HAART与阿霉素、博莱霉素和长春新碱(ABV)联合化疗进行比较，发现联合化疗的肿瘤消退率明显更高，同时生活质量得到改善，对艾滋病毒控制没有不良影响。其他研究表明，在HAART和ABV失败后，吉西他滨可能是一种有效的二线化疗药物，并提示儿童艾滋病相关KS可能对HAART的化疗反应良好。也有(主要是回顾性的)数据表明HAART对KS有有益的影响，但也有一些证据表明KS是免疫重建炎症综合征的表现。有机会和需要进行前瞻性研究，为SSA中KS的最有效治疗建立循证指南。
The purpose of this review is to summarize recent published literature on treatment of AIDS-associated Kaposi sarcoma (KS), the most common HIV-associated malignancy and a leading cancer diagnosis in sub-Saharan Africa (SSA), and to highlight the challenges faced in treating KS in this resource-limited environment. There are few prospective clinical trials for KS treatment in SSA, along with a relatively poor cancer treatment infrastructure, leading to late diagnosis and poor access to therapy. The only prospectively-randomized trial of chemotherapy compared antiretroviral therapy (HAART) alone to HAART with combination chemotherapy with doxorubicin, bleomycin and vincristine (ABV), and documented a significantly higher rate of tumor regression for the combination along with improvement in quality of life and no adverse effects on HIV control. Other studies suggest that gemcitabine may be an active second-line chemotherapeutic agent after failure of HAART and ABV and suggest that AIDS-associated KS in children may respond well to HAART with chemotherapy. There are also (primarily retrospective) data suggesting a beneficial effect of HAART on KS, but some evidence for KS as a manifestation of immune reconstitution inflammatory syndrome. Opportunities and need exist for prospective research to establish evidence-based guidelines for the most effective treatments for KS in SSA.