Chemotherapy for Kaposi's sarcoma
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. There are different ways in which chemotherapy can be given to treat KS.
Chemotherapy injected into the skin
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For small KS lesions that only affect the skin, chemotherapy is injected directly into the skin lesions. This is known as intralesional chemotherapy. It may be used instead of radiotherapy for areas or skin types where radiotherapy might cause darkening of the skin, particularly on the face. Intralesional chemotherapy can also be used for tumours inside the mouth.
The chemotherapy drug vinblastine (Velbe®) is often used and it works best on smaller lesions. Intralesional chemotherapy can shrink skin lesions and make them lighter in colour. In some people lesions may almost disappear completely.
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A type of chemotherapy drug called liposomal chemotherapy is recommended as the first systemic treatment for KS. The molecules of the drugs are enclosed (encapsulated) in a fat-based coating known as a liposome. Liposomes are able to travel to the tumour site, where they release the drug. The advantage of this type of chemotherapy is fewer side effects, which means treatment can be given over a longer period.
The liposomal chemotherapy drugs that are commonly used to treat KS are:
These drugs are usually given as drips (infusions) every 2-3 weeks.
Chemotherapy injected into a vein
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When KS is widespread on the skin or affects organs inside the body, chemotherapy is usually given into a vein. This is known as intravenous chemotherapy. The chemotherapy drugs travel in the bloodstream and reach KS in different parts of the body. This is sometimes called systemic treatment.
Chemotherapy into the vein is given as a session of treatment, usually over a few hours. This is followed by a rest period, which allows your body to recover from any side effects before you have your next course of chemotherapy. Your specialist will be able to tell you how many courses of chemotherapy you’ll have.
Some other chemotherapy drugs which may be used to treat KS are:
Side effects of chemotherapy
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Chemotherapy can cause side effects but they can often be well controlled with medicines. The side effects usually gradually disappear once your treatment is over. Some of the common side effects are:
Lowered resistance to infection (neutropenia)
Chemotherapy can reduce the number of white blood cells produced by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor straight away if your temperature goes above 38˚C (100.4˚F) or if you suddenly feel unwell, even with a normal temperature.
You’ll have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of white blood cells is still low.
Bruising or bleeding
Chemotherapy can also reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
This may make you feel tired and breathless.
Feeling sick (nausea) or being sick (vomiting)
Some of the drugs may make you feel sick or be sick. Your doctor can prescribe effective anti-sickness drugs (anti-emetics) to prevent or greatly reduce this. If they don’t work for you let your doctor know, as there are different drugs that can be used.
Soreness and redness of the palms of the hands and soles of the feet
If you’re being treated with Caelyx, you may develop red palms and soles of the feet. This is sometimes known as palmar-plantar, or hand-foot syndrome. It's temporary and usually improves once treatment finishes.
Sore mouth and ulcers
Some chemotherapy drugs can make your mouth sore and cause mouth ulcers. Some people find that sucking on ice may be soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicines to prevent or clear mouth infections.
Some chemotherapy drugs can make your hair fall out. You can ask your doctor whether the drugs you're taking are likely to cause hair loss. If your hair falls out, it will start to grow back again when your treatment finishes.
Chemotherapy given directly into the skin lesion (intralesional chemotherapy) may cause redness and swelling in that area. This is not unusual and the skin may break down a little before it begins to heal.
Chemotherapy into a vein (intravenous) can also cause swelling, redness or pain if it leaks out of the vein. This is known as extravasation. Tell your nurse or doctor straight away if this happens.
You may feel tired and generally weak. Allow yourself plenty of time to rest and try not to overdo things.
Although all of these side effects may be difficult to cope with at the time they will usually disappear once your treatment is over