How Kaposi's Sarcoma Is Treated

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Kaposi's sarcoma (KS) is a rare type of cancer that in the United States is mainly seen in people with advanced human immunodeficiency virus (HIV) infection. For people with HIV, the treatment is focused on managing the underlying infection. Local and systemic (whole-body) therapies may also be needed to treat KS tumors on the skin, mouth, digestive tract, or airway.

Other forms of KS affect older men of Mediterranean or Eastern European origin, organ transplant recipients, and African people without HIV. For these forms of KS, the treatment can range from chemotherapy and surgery to stopping immunosuppressive therapies.

This article looks at the underlying causes of Kaposi's sarcoma and the various treatment options for this uncommon but potentially serious form of cancer.

Healthcare provider discusses treatment for Kaposi sarcoma

pcess609 / Getty Images

Home Remedies and Lifestyle

It's important to note that there are no home remedies, herbal therapies, vitamins, or over-the-counter (OTC, without a prescription) drugs that can treat Kaposi's sarcoma in any way. They do not exist.

With that said, there are things you can do to make yourself comfortable if you have KS. Although KS lesions are typically painless, they can cause uncomfortable swelling of the legs and arms as the lesions start to invade and block lymph vessels beneath the surface of the skin.

This condition, known as lymphedema, may be eased by:

  • Propping your arm or leg on a pillow above the level of your heart
  • Applying an ice pack to affected limbs for 15–20 minutes several times a day to reduce swelling
  • Wearing compression stockings or wrapping your limb in an ACE bandage
  • Moving around to stimulate the circulation of lymph fluid
  • Using gentle massage to reduce fluid buildup

These measures do not treat KS but can help you feel more comfortable as you undergo treatment.

Prescriptions

Prescription drugs are central to the treatment of Kaposi's sarcoma. Different drugs may be used depending on the underlying cause, broadly categorized as HIV-associated and non-HIV-associated.

What Causes Kaposi's Sarcoma?

All forms are Kaposi's sarcoma are due to the combination of immunosuppression (a severely weakened immune system) and infection with a virus called human herpesvirus 8 (HHV-8).

Between 1% and 5% of the U.S. population has HHV-8, though it only causes symptoms in those with immunosuppression. By contrast, the rate of HHV-8 is between 10% and 20% in certain Mediterranean countries and 30%–80% in parts of sub-Saharan Africa.

Antiretroviral Therapy

In people with HIV, KS typically occurs when the immune system has been compromised. This is when the number of immune cells in your blood (as measured by the CD4 count) is so low that the body cannot defend itself against otherwise avoidable infections.

The immune system is considered compromised when the CD4 count is below 200. This is also known as AIDS (acquired immune deficiency syndrome). A normal CD4 count is between 500 and 1,200.

Given that Kaposi's sarcoma is linked to immune suppression, the primary form of treatment in people with HIV is antiretroviral therapy.

Antiretroviral therapy works by preventing the virus from making copies of itself. Without the means to replicate, HIV can be suppressed to undetectable levels where it can do the body little harm. This also allows the immune system to rebuild itself, ideally to a "safe zone," at which the CD4 count is above 200 (and ideally above 500).

Antiretroviral therapy involves a combination of two or more drugs. There are over 40 different antiretroviral drugs available, including a new therapy called Cabenuva (cabotegravir/rilpivirine) that can fully suppress the virus with two injections given once monthly.

Treatment Success

When taken as prescribed, antiretroviral therapy can shrink KS lesions and even achieve complete remission. It also helps prevent tumors from spreading to internal organs such as the intestines or lungs.

Other Medications

In people with HIV-associated KS, also known as epidemic Kaposi's sarcoma, other prescription drugs may be used to support antiretroviral therapy. This is especially true if the lesions have spread to internal organs.

These drugs can be also used in people with non-HIV-associated KS, including:

  • Classic Kaposi's sarcoma (found mostly in older men of Italian or Eastern European Jewish origin)
  • Transplant-related Kaposi's sarcoma (seen in organ transplant recipients)
  • Endemic Kaposi's sarcoma (confined to parts of Africa)

Chemotherapy

Chemotherapy ("chemo") is a form of cancer treatment that either kills the tumor cells or prevents them from multiplying. Adriamycin (doxorubicin) and Taxol (paclitaxel) are considered the chemo drugs of choice for KS.

The drugs can be injected into lesions (intralesional chemo) or infused into the bloodstream to treat lesions throughout the body (intravenous chemo). They can also be infused into specific body parts, such as the abdominal cavity or spinal column (regional chemotherapy), or applied directly to the skin in gel form (topical chemo).

Chemotherapy can be used in people with HIV-associated KS, classic KS, and endemic KS.

Immunotherapy

Immunotherapy is a treatment that either boosts the body's natural defenses to cancer or provides instructions to help the immune system better recognize and attack cancer cells.

The three immunotherapy agents approved for the treatment of KS are:

  • Alkaban-AQ (vinblastine sulfate): Given by an intravenous (IV) infusion or injection into a vein
  • Intron A (recombinant interferon alfa-2b): Given by IV infusion or by injection under the skin or into a lesion or muscle, but now discontinued by the manufacturer
  • Pomalyst (pomalidomide): Taken by mouth in capsule form

Immunotherapy is generally reserved for the treatment of HIV-associated KS.

How to Treat Transplant-Related KS

People with transplant-related KS will sometimes experience the spontaneous clearance of lesions, when lesions clear without treatment. Others may need to stop or switch the immunosuppressant drug they are using to prevent organ transplant rejection.  The antirejection drug Rapamune (sirolimus) is sometimes used for people who need to switch.

Surgeries and Specialist-Driven Procedures

In addition to medications, there are several specialist-driven procedures that may be used to treat HIV-associated KS, classic KS, and endemic KS.

Radiation Therapy

Radiation therapy uses ionizing radiation (the same used for X-rays) in high doses to kill cancer cells or keep them from growing.

The two types of radiation that can be used to treat KS are:

  • External radiation therapy: This involves a targeted beam of radiation that is directed at a specific area on or inside the body. Options include photon-beam radiation, which uses high-energy light, or electron-beam radiation, which uses negatively charged particles called electrons.
  • Internal radiation therapy: Also known as brachytherapy, this involves the placement or implantation of a radioactive substance (such as a needle, wire, or seed) inside of the body.

Surgery

Surgery may be pursued if the KS lesions are small, few in number, and limited to the surface of the skin. Surgery is generally avoided for more widespread cases as new lesions will often develop along the edges of the wounds.

Surgical procedures used to treat cutaneous (skin) KS include:

  • Local excision: This is the removal of a tumor with a scalpel along with a small margin of surrounding tissue. The surgery usually involves local anesthesia to numb the skin. Sutures may be needed to close larger wounds.
  • Electrodesiccation with curettage: This involves the removal of a tumor under local anesthesia with a cup-shaped cutting tool called a curette. A needle-shaped electrode then applies electricity to destroy any remaining cancer cells around the edges of the wound. Electrodesiccation and curettage (ED&C) is used to treat many types of skin cancer.
  • Cryosurgery: This involves the application of liquid nitrogen to a lesion to freeze and kill cancer cells. Carbon dioxide or argon gas can also be used. Cryosurgery is also often performed with a local anesthetic.

Summary

Kaposi's sarcoma (KS) is a rare form of cancer that is mainly associated with advanced HIV infection. The treatment of HIV-related KS is focused on restoring the immune function with antiretroviral therapy. By doing so, many of the KS lesions will shrink or entirely disappear.

Other forms of treatment may be needed for more serious cases, including chemotherapy, immunotherapy, radiation therapy, and surgery. Some of these same treatments also treat non-HIV-related Kaposi's sarcoma (including so-called "classic KS" often seen in older men of Mediterranean or Eastern European Jewish descent).

A Word From Verywell

Although Kaposi's sarcoma is less common today than in past decades, thanks to the widespread use of antiretroviral therapy, it still occurs and can be serious. Depending on how severe or widespread the condition is, you may need treatment from an infectious disease specialist, a dermatologist, and a cancer specialist (such as a radiation or medical oncologist).

When KS is advanced, it can be difficult to treat. If you are unable to tolerate certain medications or if all available treatments fail to provide relief, speak with your healthcare provider about enrolling in a clinical trial. Studies are underway to explore the use of targeted drugs such as Avastin (bevacizumab) to improve response rates in people with treatment-resistant KS.

Frequently Asked Questions

  • How effective are antiretrovirals in curing Kaposi's sarcoma?

    Antiretroviral therapy (ART) can be very effective in treating HIV-related KS. Studies have shown that complete remission is possible in 20% to 80% of people on ART. Remission rates are lower for people who delay treatment until HIV is advanced or fail to take their medications consistently.

  • What happens if you don't treat Kaposi's sarcoma?

    If you have KS, it is because your immune system is severely weakened, increasing your risk of opportunistic infections. If left untreated, KS can cause tumors to spread to the airways (causing breathing problems, chest pain, fever, and the coughing up of blood) or digestive tract (causing weight loss, diarrhea, nausea, bowel obstruction, and bloody vomit or stools).

  • Are there alternative therapies for Kaposi's sarcoma?

    No complementary or alternative therapy has been proven effective in treating any form of KS. Shark cartilage derived from the spiny dogfish shark and hammerhead shark has long been promoted as a dietary supplement to treat cancer, including KS. To date, there is no credible evidence to support the claim.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By James Myhre & Dennis Sifris, MD
Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.