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Kaposi Sarcoma — SCE Medical Oncology MCQ

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ModerateSarcomaKaposi SarcomaSCE Medical Oncology

A 55-year-old man with Kaposi sarcoma (KS) associated with HIV presents with widespread cutaneous lesions and visceral involvement. His CD4 count is 85 cells/µL. He is starting antiretroviral therapy (ART). What additional systemic therapy is indicated for advanced KS?

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Correct answer: D — Liposomal doxorubicin (Caelyx/Doxil) combined with ART initiation — ART restores immune control of HHV-8, while chemotherapy addresses the advanced disease burden

Kaposi sarcoma is caused by HHV-8 (human herpesvirus 8). For HIV-associated KS with limited cutaneous disease, ART alone (immune reconstitution) may be sufficient. For advanced KS (visceral involvement, widespread cutaneous disease, lymphoedema, rapidly progressive disease), liposomal doxorubicin is the standard first-line systemic therapy alongside ART. Paclitaxel is second-line. Pomalidomide has shown activity in third-line. Immune checkpoint inhibitors are being evaluated but carry risk of immune reconstitution inflammatory syndrome (IRIS) with ART.

Reference: ESMO 2024 STS/Non-melanoma Skin Cancer; NICE; BHIVA KS Guidelines