Sarcoma - Kaposi: Types of Treatment

Approved by the Cancer.Net Editorial Board, 07/2019

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with Kaposi sarcoma. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the common types of treatments used for Kaposi sarcoma are listed below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called "shared decision making." Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for Kaposi sarcoma because there are different treatment options. Learn more about making treatment decisions.

Antiretroviral treatment

For people with epidemic Kaposi sarcoma, antiretroviral treatment (ART) for HIV/AIDS is usually used before any other treatments to treat the tumor and reduce symptoms. ART may be given by itself or in combination with chemotherapy (see below), depending on the spread of the disease and the person's symptoms.

Rarely, ART can make preexisting infections and the Kaposi sarcoma worse. This reaction is called immune reconstitution inflammatory syndrome (IRIS). If symptoms get worse in the first few weeks after starting ART, talk with your doctor.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgery may be performed by a surgical oncologist. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery is most useful when the lesions are located in a single area or a few specific areas. There are 2 types of surgical procedures used for Kaposi sarcoma:

  • Curettage and electrodesiccation. During this procedure, the cancer is removed with a sharp, spoon-shaped instrument called a curette. The area can then be treated with electrodesiccation, which uses an electric current to control bleeding and destroy any remaining cancer cells. This procedure may leave a flat, pale scar.

  • Cryosurgery. Cryosurgery uses liquid nitrogen to freeze and destroy cells. The skin will later blister and fall away. This procedure will sometimes leave a pale scar. More than 1 freezing may be needed. This procedure is also called cryotherapy or cryoablation.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

Photodynamic therapy

During photodynamic therapy, a light-sensitive substance is injected into the lesion. This substance remains in the cancer cells longer than in the healthy cells. A laser is then directed at the lesion to destroy the cancer cells that have absorbed the light-sensitive substance.

Radiation therapy

Radiation therapy uses high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. It may also be given as a palliative treatment to improve quality of life by treating symptoms and side effects. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.

A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

Treatment may cause a rash, dry or red skin, or skin color changes. Other side effects from radiation therapy may include fatigue, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for Kaposi sarcoma include:

  • Chemotherapy

  • Topical medications

  • Targeted therapy

  • Immunotherapy

Each of these types of therapies are discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. Sometimes, chemotherapy is injected directly into the lesion to destroy the cancer cells. This is called an intralesional injection. Intralesional injections to treat Kaposi sarcoma often use vinblastine (Velban).

A patient may receive 1 drug at a time or a combination of different drugs given at the same time. Common drugs used for epidemic Kaposi sarcoma include liposomal doxorubicin (Doxil), paclitaxel (available as a generic drug), and vinorelbine (Navelbine).

The side effects of chemotherapy depend on the specific drug and the dose used, but they may include nausea and vomiting, hair loss, loss of appetite, diarrhea, fatigue, low blood count, bleeding or bruising after minor cuts or injuries, numbness and tingling in the hands or feet, headaches, and darkening of the skin and fingernails. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy.

Topical medications

The treatment plan may include skin creams to shrink or stop the growth of lesions. Topical creams often do not stop all the cancer, but they can improve a person's appearance. Imiquimod (Aldara) cream is used to treat many skin conditions, including basal cell carcinoma and Kaposi sarcoma. Alitretinoin (Panretin) is a gel medication that is related to vitamin A that can make lesions from Kaposi sarcoma go away. The gel is put on the lesions for many weeks.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Targeted therapy for Kaposi sarcoma includes:

  • Kinase inhibitors. Blood vessels make up a large part of Kaposi sarcoma lesions, so researchers are studying treatments focused on stopping angiogenesis, which is the process of making new blood vessels. The goal of anti-angiogenesis therapy using kinase inhibitors is to block the formation of new blood vessels so that the nutrients a tumor needs to grow and spread cannot be delivered. This causes the tumor to "starve."

  • Immune modulating drugs. Immune modulating drugs are medications that change the way the body's immune system works. Research led by the National Cancer Institute found that lenalidomide (Revlimid) was useful in treating people with Kaposi sarcoma. Lenalidomide targets a different pathway from kinase inhibitors and stops the growth of myeloma cells in the bone marrow. It is also used to treat multiple myeloma. Another medication that is similar to lenalidomide, pomalidomide (Pomalyst), may be effective in treating people with Kaposi sarcoma, regardless of whether they have HIV. Lenalidomide and pomalidomide are only available in clinical trials.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Sometimes, Kaposi sarcoma responds to alpha-interferon (Roferon-A, Intron A, Alferon), which appears to work by changing proteins on the surface of the cancer cells and by slowing their growth.

Different types of immunotherapy can cause different side effects. Common side effects of immunotherapy for Kaposi sarcoma are decreased white blood cell count and flu-like symptoms. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Widespread (disseminated) Kaposi sarcoma

In other types of cancer, if cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. Because Kaposi sarcoma commonly affects more than 1 area of skin, it is difficult to indicate what is “metastatic” compared to other cancers. However, Kaposi sarcoma is considered more serious if it involves organs other than the skin, such as the lungs, liver, or gastrointestinal tract. If this happens, it is a good idea to talk with doctors who have experience in treating widespread Kaposi sarcoma. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of surgery, radiation therapy, and chemotherapy. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of widespread Kaposi sarcoma is very stressful and, at times, difficult to bear. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or  NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as antiretroviral treatment, surgery, chemotherapy, radiation therapy, and immunotherapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.