The hope of immunotherapy
Immunotherapy may be effective in patients with HIV-associated Kaposi's sarcoma concludes this UC San Diego Health study of a small cohort of patients treated with immune checkpoint inhibitors who, at 65%, achieve partial or complete remission. Data presented in the journal Cancer Immunology Research which brings hope to the 15% of HIV-positive patients who, despite antiretroviral treatments, will develop sarcoma.
The author, Dr. Natalie Galanina, an oncologist at the Moores Cancer Center at the University of California San Diego sums up this need: Kaposi's sarcoma, an incurable malignancy resulting in significant morbidity. Due to the lack of new therapeutic options for this disease, we wanted to investigate whether immune checkpoint inhibition was effective in this viral-mediated cancer treatment.” Liposomal doxorubicin, a chemotherapy drug, is the standard of care for patients with Kaposi's sarcoma. While nearly half of patients respond to this therapy, most suffer from relapses and require repeated treatments. Since Kaposi's sarcoma can persist in patients with an undetectable viral load, there is a significant need for new treatments.
Immunotherapy that boosts the immune system:
Dr. Galanina's team followed 9 patients with Kaposi's sarcoma treated with an anti-PD-1 immune checkpoint inhibitor. This immunotherapy consists of “unlocking” one of the checkpoints, here PD-1 which helps to slow down the immune system. The checkpoint inhibitor will thus allow the immune system to fight more effectively against tumor cells (see visual).All participants had received antiretroviral therapy and initial treatment for their sarcoma. Researchers analyzed DNA sequencing data from tumors and tissues to assess expression levels of tumor burden and PD-L1, biomarkers of anti-PD-1 treatment. This small trial finds that after treatment with checkpoint inhibitor,
- 5 patients show a partial response,
- 3 patients are "stable",
- 1 patient presents a complete remission.
- All patients remained on treatment and no patient showed disease progression at 6.5 months follow-up.
- PD-L1 expression became negative in the 4 evaluable patients.
Thus, checkpoint blockade immunotherapy elicits a response in many patients and may represent a promising new treatment option for HIV-associated Kaposi's sarcoma. Data that will need to be validated on a larger sample.
Can sarcoma be treated with immunotherapy?
Immunotherapy is revolutionizing the way many cancers, including sarcomas, are treated. While conventional treatments such as surgery, chemotherapy and radiation therapy are more commonly used to address sarcoma, immunotherapy may be a viable treatment approach for certain patients.
What is the best treatment for Kaposi sarcoma?
Liposomal doxorubicin is used to treat Kaposi sarcoma. The liposomes build up in Kaposi sarcoma tissue more than in healthy tissue, and the doxorubicin is released slowly. This increases the effect of the doxorubicin and causes less damage to healthy tissue.
What is the most common successful treatment for KS?
Classic Kaposi sarcoma
Classic KS grows and spreads slowly, so lesions are more often treated with surgery, radiation therapy, or another local treatment like intralesional chemotherapy. Chemotherapy may be used for widespread skin lesions or for KS that is in the lymph nodes, the lungs, or the digestive tract.
What are the goals of immunotherapy?
The goal of immunotherapy is to marshal the specificity and long-term memory of the adaptive immune response to achieve durable tumor regression and possible cure, although, to date, this has been achieved in only a small subset of patients.
How successful is immunotherapy?
Immunotherapy drugs work better in some cancers than others and while they can be a miracle for some, they fail to work for all patients. Overall response rates are about 15 to 20%.
Is immunotherapy a permanent cure?
Maintenance immunotherapy treatment is generally continued for 3 to 5 years. Some people have lasting remission of their allergy symptoms but others may relapse after discontinuing immunotherapy, so the duration of allergen immunotherapy varies from person to person.
Can you recover from Kaposi sarcoma?
Most people with HIV-related Kaposi's sarcoma can be successfully treated with a combination of antiretroviral therapy and chemotherapy. Once the immune system has fully recovered, it's unlikely to relapse.
Can Kaposi sarcoma be healed?
Currently, no treatment is available to eradicate HHV-8 infection. Therefore, there is no cure for Kaposi sarcoma (KS). Instead, the purpose of therapy in all forms of KS is directed at alleviating symptoms and slowing disease progression.
Does chemotherapy cure Kaposi sarcoma?
More than half of KS patients treated with chemo will improve, but KS generally doesn't go away completely. Sometimes chemo can be stopped as long as lesions are not causing problems or increasing in size and number. If the KS starts to get worse, treatment may be restarted.
How fast does Kaposi sarcoma spread?
Classic Kaposi sarcoma is more common in men than in women, and lesions may develop slowly over a period of 10 to 15 years.
Is Kaposi sarcoma serious?
KS can cause serious problems or even become life threatening when the lesions are in the lungs, liver, or digestive tract. KS in the digestive tract, for example, can cause bleeding, while tumors in the lungs may cause trouble breathing.
