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Journal of the Dermatology Nurses' Association

October 2010, Volume 2 Number 5 , p 231 - 232

Author

  • Erin Dahlke

Abstract

Brambilla L, Bellinvia M, Tourlaki A, Scoppio B, Gaiani F, and Boneschi V. (2010). Intralesional vincristine as first-line therapy for nodular lesions in classic Kaposi sarcoma: A prospective study in 151 patients. British Journal of Dermatology, 162, 854-859.Kaposi sarcoma, a rare angioproliferative disease associated with human herpes virus 8, typically presents as red-purple papules, nodules, or plaques. There are four clinical subtypes of Kaposi sarcoma: classic, endemic African, AIDS-related, and non-AIDS-related immunodeficiency associated. Classic Kaposi sarcoma occurs most often in men older than 50 years, with the highest prevalence in the Mediterranean area.Vincristine, an antimitotic chemotherapeutic drug used intravenously to treat hematologic neoplasms, has been used off label intralesionally to treat Kaposi sarcoma; however, there is very little literature published onthis topic. The standard of care for limited cutaneous Kaposi sarcoma involves local therapies such as excision, liquid nitrogen, laser, photodynamic therapy, or radiation therapy.This group conducted a prospective, open-label trial in 151 patients with classic Kaposi sarcoma. All cases were histologically confirmed, HIV negative, and stage IB (meaning rapidly evolving typical Kaposi nodules on the lower limbs with no major complications and no visceral involvement). Only one nodule per patient was treated, and a second similar lesion on the same limb at least 10 cm apart, or on the contralateral limb, was used as a control. The target lesions were infiltrated with 0.03 to 0.08 ml of vincristine sulfate, with the amount injected proportional to the size of the nodule.They observed a very good clinical response, with a total response rate of 97.8%. At 4 weeks, 89 lesions showed a complete response (meaning complete resolution of the lesion) and 54 had a partial response (meaning a reduction of 50% or more in nodule diameter). By 12 weeks, 115 had a complete response, 28 had a partial

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