Clinical activity of lenalidomide in visceral human immunodeficiency virus-related Kaposi sarcoma

• Published in: JAMA dermatology (Chicago, Ill.) Vol. 149; no. 11; p. 1319
• Main Authors: Steff, Maud, Joly, Véronique, Di Lucca, Julie, Feldman, Judith, Burg, Samuel, Sarda-Mantel, Laure, Peytavin, Gilles, Marinho, Eduardo, Crickx, Béatrice, Raymond, Eric, Lariven, Sylvie, Maubec, Eve
• Format: Journal Article
• Language: English
• Published: United States 01.11.2013
• Subjects: African Continental Ancestry Group; AIDS-Related Opportunistic Infections - diagnostic imaging; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - pathology; Angiogenesis Inhibitors - therapeutic use; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Compassionate Use Trials; HIV-1 - physiology; Humans; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - drug therapy; Lung Neoplasms - secondary; Lymphatic Metastasis; Male; Middle Aged; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - secondary; Sarcoma, Kaposi - diagnostic imaging; Sarcoma, Kaposi - drug therapy; Sarcoma, Kaposi - pathology; Thalidomide - analogs & derivatives; Thalidomide - therapeutic use; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Viral Load
• ISSN: 2168-6084
• DOI: 10.1001/jamadermatol.2013.5751

Curative treatment of aggressive Kaposi sarcoma (KS) with conventional chemotherapy in human immunodeficiency virus (HIV)-infected patients remains difficult. The administration of thalidomide, an immunomodulatory drug with antiangiogenic effects, is limited by its toxicity. This engenders interest in evaluating thalidomide analogues such as lenalidomide with better toxicity profiles. To our knowledge, we describe for the first time a patient with visceral KS successfully treated with lenalidomide. A man with advanced visceral HIV-related KS progressing after 11 months of highly active antiretroviral therapy (HAART) and 2 lines of conventional chemotherapy (pegylated liposomal doxorubicin and docetaxel) was treated with lenalidomide on a compassionate use basis. He showed a rapid partial response without any substantial adverse effect but experienced relapse after 5 months of treatment, in a context of virologic failure. Similar to our observation, good partial response without toxic effects has been reported in 3 patients with only skin involvement. Because immune reconstitution syndrome may occur in HIV-infected patients with KS undergoing HAART, KS improvement may be partly explained by immune recovery. An ongoing US phase 1/2 trial will better evaluate the efficacy and tolerance of lenalidomide in patients with HIV-related KS with and without visceral involvement.