Kaposi Sarcoma: Chemotherapy 

What is chemotherapy?

Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.

How is chemotherapy given for Kaposi sarcoma?

Before treatment starts, you will meet with a medical oncologist. This is a doctor who specializes in treating cancer with medicines such as chemotherapy. The doctor will discuss your treatment options with you and explain what you might expect. 

Depending on the specific chemotherapy medicines you are getting and the reasons you are getting them, chemo can be given in different ways: 

• IV (intravenous). The chemo is given through a small needle that has been put into a vein. The drug may drip in slowly over several hours, or it may be given more quickly over a few minutes. When given this way, the chemo enters the blood and can reach cancer cells all over the body.

• Intralesional. The chemo drug is injected directly into 1 or more KS lesions. The advantage of giving chemo this way is that most of it stays just in the area where it was injected. This limits the side effects it causes. But chemo given this way can only treat the lesions it is injected into. It can’t reach cancer cells in other parts of the body.

Chemotherapy is usually given in an outpatient setting. That means that you get it at a hospital, clinic, or healthcare provider's office, and you can go home after the treatment is given. Less often, you may need to stay in the hospital during treatment. You'll be watched for reactions during your treatments. Each of your chemotherapy treatments may last for a while. So you may want to take along something that is comforting to you, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

To reduce the damage to healthy cells and give them a chance to recover, chemotherapy is often given in cycles. Each cycle consists of 1 or more days of treatment, followed by some time to rest. Your healthcare provider will discuss your chemotherapy schedule with you.

When might chemotherapy be used for Kaposi sarcoma? 

Chemotherapy can be used to treat KS in different situations.

• Intralesional chemotherapy might be used to treat KS lesions that have affected how you look, or that are causing symptoms such as swelling or pain. Intralesional chemo can often shrink these lesions. But it does not stop new lesions from forming in other parts of your body.

• IV chemo is often used as part of the treatment for more advanced KS, or KS that is progressing quickly. For AIDS-related KS, chemo is typically given along with antiretroviral therapy (medicines to treat the HIV infection).

What chemo drugs are used to treat Kaposi sarcoma?

If IV chemotherapy is needed to treat KS, medicines called liposomal anthracyclines are usually the first ones used. These are chemo medicines inside tiny fat bubbles called liposomes. The fat bubbles help the medicine work more effectively and help prevent side effects.

The currently approved liposomal anthracyclines are:

• Liposomal Doxorubicin

• Liposomal Daunorubicin

These medicines often produce good and long-lasting responses in many people by shrinking tumors and reducing swelling.

Other chemo medicines used to treat KS include:

• Bleomycin

• Etoposide

• Gemcitabine

• Paclitaxel

• Vinblastine

• Vincristine

• Vinorelbine

Vinblastine is the most common drug used for intralesional chemotherapy.

What are common side effects of chemotherapy?

Side effects of chemotherapy are different for everyone and vary based on the medicine you receive. Below is a list of the some of the most common side effects from chemotherapy. Most of these side effects are much more common for IV chemo than for intralesional chemo. Ask your doctor or chemotherapy nurse for details about the side effects for the medicines you are getting.

• Hair loss. If you have hair loss, the hair will usually grow back after the treatment stops.

• Nausea and vomiting. This side effect can be usually controlled with medicines. Ask your healthcare provider about it.

• Mouth sores. Chemo can sometimes cause mouth sores, which might make it hard for you to eat or swallow. It's important to keep your mouth very clean and avoid foods and substances that could irritate your mouth.

• Diarrhea. If you have diarrhea, take antidiarrheal medicines as prescribed by your health care provider. You may also need to make changes in your diet.

• Loss of appetite or changes in the way things taste. Talk to your healthcare provider if you find you are having trouble eating or are losing weight. There are often ways to help.

• Increased risk of infection. During your chemo treatments, your white blood cell count may become low. This means your immune system won’t be working as well as it usually does. It’s a good idea for you to avoid people who have illnesses that you could catch. It’s also a good idea to take extra precautions against cuts and scrapes that could become infected. Your healthcare provider will check your blood counts regularly during your treatment. Be sure to let your doctor or nurse know if you have any signs of possible infection. This includes a fever, sore throat, a new cough, or burning during urination.

• Bleeding and bruising more easily. Chemo can also lower your blood platelet counts. Platelets are needed to help the blood clot properly. 

• Fatigue. You may feel tired while getting chemotherapy. This usually goes away once treatment ends. 

Some other side effects can also be seen with certain chemo medicines. For example, vincristine, paclitaxel, and some other drugs can cause nerve damage (neuropathy). This can lead to pain, tingling, and numbness in your hands and feet. 

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. For example, chemotherapy can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.