KAPOSI SARCOMA
Classic Kaposi Sarcoma (KS): Local and Systemic Treatments
Surgery (Local)
What does it involve?
Things to Consider:
Radiation Therapy (Local)
What does it involve?
Things to Consider:
Preferred Treatment Course:
Treatment Options for Classic Kaposi Sarcoma
Seline Tam, Aja Toste, Rita Vitorino, Yupeng Yan 2017
Can involve an individual excision (i.e. a single cut to the skin) to a local
tumour however; lesions commonly develop at other sites or reoccur at
the same sites on the skin [1,2]
Following surgery, hydrogen peroxide may be applied topically (as a
cream or lotion) to prevent future development of Kaposi sarcoma
lesions [1,2]
Can also be performed via electrodessication which uses an electrode
to treat the area with electric current to destroy cancer cells and stop
bleeding in area [1,2]
The surgeries of single excisions or multiple excisions may not be
sustainable for containment or management of lesion development
long-term [1,2]
Multiple surgeries may be considered physically exhausting and
emotionally draining [1,2,3]
Scars may develop from healing after surgery [3]
Exposure to primarily an x-ray machine that targets cancer cells and
prevent growth. The therapy can be either:
External radiation: where the x-ray targets from outside of the
body to inward. There are two main types of external radiations:
1) photon radiation therapy that is considered high energy levels
and 2) electron beam radiation that uses electrons (small
subatomic particles) to target cancer cells. For more information
on these types of radiation: http://www.cancer.net/navigating-
cancer-care/how-cancer-treated/radiation-therapy/proton-
therapyand http://www.cancercenter.com/soft-tissue-
sarcoma/ebrt/[5,6]
Internal radiation: where radioactive substances are inserted into
the body via needle, or catheters (tubing) near or on the cancer
cells directly to destroy them [1,2]
Local lesion and symptom relief can be achieved in about 90% of
cases BUT further treatment may be required via use of other
types of systemic therapies (such as chemotherapy or
immunomodulators) due to the presence of HHV-8 (Human
Herpesvirus-8, a tumour virus that is a key factor of KS
development) [2]
Can be used for single lesions or systemic lesions [2]
KS is very sensitive to radiation therapy [2]
Treatment may only require a weekly visit to hospital vs other
treatments that might be more extensive [2]
Weekly session with a total of 3-4 sessions over a local lesion field
using electron beam therapy [2]
Continues on the next page
1

Radiation Therapy (Local, Continued)
Nursing Implications:
Low Voltage Photon
Radiation [4]
and
X-Ray Radiation [4]
Electron- Beam Radiation
Therapy (EBRT) [4]
KAPOSI SARCOMA
Patient education on how to take care of skin during treatment [2]
Emotional support with any body changes or changes in
confidence, production of body image issues/concerns [3]
Monitor for changes in skin during treatment, especially for
radiation of skin concerns outside localized area of treatment [2]
Encourage periods of rest [3]
Administer anti-emetics [2, 7]
Typical Dosage: 8 Gy* to 10 Gy in a single dose; 1 treatment = 15-
30 minutes; total dose in 1 week= 15-20 Gy
Route: X-Ray
Side Effects: Fatigue, skin redness, irritation, swelling, dryness,
blistering or peeling
Specific Nursing Implications:
Patient education on how to take care of skin during treatment
Monitor for changes in skin during treatment
Monitor for radiation of skin concerns outside localized area of
treatment
Emotional support with body changes
Typical Dosage: 4 Gy given once weekly; total given, 24-32 Gy
within 6-8 weeks
Route: X-Ray linear accelerator with 4-meV to 6-MeV electron beam
with port that encompasses 15cm of skin surface above lesion
Side Effects: Skin change, fatigue and nausea
Specific Nursing Implications:
Patient education on how to take care of skin during treatment
Monitor for radiation of skin concerns outside localized area of
treatment
Emotional support with body changes
Encourage periods of rest
Administer anti-emetics

Cryotherapy (Local)
What does it involve? Requires a needle filled with liquid nitrogen to be applied to the skin to
control for small, local lesions. A dermatologist typically performs this
treatment[1,2] .
Treatment doses: Can be performed once or as needed; dosing up to discretion of
dermatologist, side effects not unknown [2]
Things to consider: This is primarily a cosmetic effect [2]
Nursing implications: Monitor sites for signs of infection (redness, swelling, heat, purulent
discharge, etc.) [8, 9]
Encourage patients to discuss their concerns or issues with any
changes in their bodies [3]
Administer anti-emetics for individuals with severe anxiety or history of
emesis, who are on chemotherapy or radiation therapy simultaneously
[2, 7]

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Intralesional Therapy (Local)
What does it involve?
Treatment doses: Twice- or thrice-weekly injections over a period of four to six weeks [2]
Side Effects: Treatment is considered painful, and can lead to scarring [2]
Things to consider:
Nursing implications:
KAPOSI SARCOMA
Injection of chemotherapy (usually vinblastine, vincristine or
doxorubicin) or an antibiotic (bleomycin) that results in the destruction
of lesions [1, 2]
Can be done using electrochemotherapy uses a small electric current
(electroporation, a form of electromotive drug administration) to
increase drug delivery into the tumor; this approach has been used
primarily with bleomycin [1, 2]
Has resulted in eradication of some tumours (that are considered
directly injectable) with approximately 65% response rate (particularly
with electrochemotherapy use) [2]
Best candidate criteria: have nodular lesions without visceral
involvement (internal organ spread), and have fewer than 10 lesions on
the skin [2]
May require use of general or spinal anaesthesia [2]
Can be combined with interferon alfa treatment (immunotherapy)[2]
Monitor pain during treatment and administer analgesics if appropriate
or provide non-pharmacological pain management techniques if
possible [9]
Be mindful of which patients would be eligible for this type of treatment
requires advocacy for the patients [2]

Topical and Oral Therapies (Local)

What does it involve? Involves application of a cream, lotion, or ointment into the skin to reduce
lesions by regulating endothelial growth factors. This treatment is not as
commonly used. Oral therapies involve ingestion of medications in order to
reduce lesion growth, prevent lesion development, or eradicate lesions
entirely [2]
Alitretinoin (Panretin) Dosing: apply gel twice daily to lesions directly and wait 3-5 minutes after
application for gel to dry before putting on clothes, can increase dosing to
3-4 times a day maximum (as tolerated) [2]
Side Effects: pain, paresthesia, skin rash, pruritus (itchiness), edema
(swelling), can cause photosensitivity (aversion to light) [2]
Nursing Implications: this drug is considered a high alert medication; may
be confused with Pancreatin; not to be administered to patients that have
hypersensitivities or allergic reactions to retinoids; cannot be used if a
person is pregnant [2]
Nicotine patches Can be associated with reduced risk of Classic KS but does not create
significant effects on already developed lesions; is in the process of being
furthered studied as a treatment for Classic KS [2]

Continues on the next page

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Topical and Oral Therapies (Local, Continued)
Imiquimod (Vyloma) Dosing: If 2.5 or 3.75% amount then apply a thin amount of cream (either
2 pumps or packets) daily before bedtime for 2 weeks; if 5% cream then
apply 1 packet per application twice a week before bedtime and remove in
morning with mild soap and water [2] Always wash hands before and after
application [2]
Side Effects: chest pain, headache, fatigue, dizziness, skin pain, may
increase serum glucose, nausea, diarrhea, UTI, skin irritation, flu-like
symptoms, fever, and back pain [2]
Nursing Implications: monitor for adverse reactions such as erythema,
edema, skin erosion, infection, scabbing, flu-life reactions, chest pain,
headache, or pain; may be confused with Alora or Lialda (if using US
brands); monitor glucose levels; monitor and manage pain; no
contraindications [2]
Rapamune (Sirolimus) Was only reported in regression of KS lesions in one case after 16
weeks; newly investigated treatment and dosing/impacts are not well-
known in application to KS [2]
The study related to application of Rapamune for Classic KS can be
found here: https://www.ncbi.nlm.nih.gov/pubmed?term=25314592 [2]
Timolol (Apo-Timop or Dosing: Ophthalmic application (aka eye drops) with 1 drop in each eye
Timoptic) once daily either in 0.25% or 0.5% concentrations [2]
Note: for contact lens wearers, remove your lens prior to administration
and wait for 15 minutes after application before reinserting [2]
Side Effects: burning or stinging sensations in the eyes, amnesia, anxiety,
dizziness, disorientation, insomnia, angioedema and peripheral edema,
alopecia (hair thinning or hair loss), hypertension, hypoglycemia,
myasthenia gravis, nausea, diarrhea, impotence, tinnitus (ringing of the
ears), blurred vision, decreased visual acuity, pulmonary edema, cough,
dyspnea [2]
Nursing Implications: may be confused with atenolol or Tylenol; monitor
and management pain, perform Glascow Coma scale and CAM
assessments before each treatment, monitor glucose levels, monitor BM,
notice for any signs of allergic reactions, monitor vitals for signs of
hypertension, monitor for shortness of breath and note to potential
crackles/rales/wheezes [2]
Contraindications: do not take if you have a history of bronchial asthma,
chronic obstructive pulmonary disease (COPD), sinus bradycardia, have a
history of cardiogenic shock or are taking ophthalmic beta-adrenergic
blocking agents, acetylcholinesterase Inhibitors, alpha-2 agonists, or
aminoquinolines. For a full list of contraindications please visit:
https://www.uptodate.com/contents/timolol-ophthalmic-drug-
information?source=preview&anchor=F9600187#F9600187 [2]

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There are 2 types of systemic treatment that are geared towards total regression of KS at all disease
sites. These systemic treatments are proven most effective in long-term implications and disease
progression of Classic Kaposi Sarcoma, but it is also important to note that these treatments can
produce a vast amount of side effects, and/or can be lengthier treatment regimens. [1, 2]

Immunomodulators (Systemic)
What does it involve? It involves the use of Recombinant interferon alpha (IFNa) protein in order
to either boost your natural immune system, create antiviral effects,
prevent the tumour from accessing your blood vessels in order to grow
(angiogenesis), or will stop cancer cells from growing (known as
antiproliferative effects). The exact processes are unknown at this moment
but this therapy is more used with AIDS-related Kaposi Sarcoma) [2,8]
Recombinant Antineoplastic Agent or Interferon
Interferon Alfa-2b (IFN) Inhibits DNA and protein synthesis of tumour cells
[4, 8] Increases natural killer cells cytotoxic effects
Inhibits replication of viral DNA
Dosing:
30 million units/m2 3 times weekly until 16 week total treatment
Delay treatment if ANC <500/mm3 or platelets <25,000/mm3
Route: Intramuscular (IM) or subcutaneous (SC)
Absorption:
Bioavailability: IM: 83%; SC: 90%
Half-life: IM, SC: ~2-3 hours
Side Effects: Fever, chills, tachycardia, myalgia, headache, chest pain,
depression, confusion, and lack of concentration (cognitive changes),
weight loss, fatigue, alopecia, pruritus, nausea and vomiting, cough,
dyspnea, back pain, weakness, edema, hypertension, urinary tract
infection risks
Nursing Implications:
Patients with pre-existing cardiac abnormalities or in advanced stages
of cancer should have ECGs taken before and during treatment
Monitor for neuropsychiatric changes, especially depression, suicidal or
homicidal ideation, psychosis, or mania; decreased pulmonary
function; or ophthalmic changes
Administer acetaminophen to reduce flu-like symptoms
Monitor vitals (including temperature)
Plan for rest periods for patient
Assist patient with ADLs
Assist with resource implementation or referral to home services (if
needed)

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Chemotherapy (Systemic)
What does it involve? It is a treatment that involves the use of drugs that aim to remove, kill,
or damage cancer cells. Chemotherapy drugs, or shortened commonly
to chemo, can be ingested via pills (oral), or given more typically
intravenously (IV, into the veins via a needle/ catheter insertion
process) [1, 2]
Since chemotherapy can involve a variety of individual drugs or drugs
used in combination, we have provided a chart that outlines all the
common types of chemotherapy you may receive, the amount (or
dose), its half life span in the body (basically how long a drug will stay
in your body), and side effects so you can be more aware of what
pharmacological methods are used to treat Classic Kaposi Sarcoma
and what you may experience during or in-between treatments. Please
note, before treatment we encourage people with Classic KS to reach
out to their healthcare professionals to learn more about what these
symptoms/conditions are and what signs to look out for.
Things to consider: Overall response rates for chemotherapy range from 60-90% and
generally treatments are well tolerated. Usually side effects will last
anywhere from 4 months to over 2 years but everyone differs. Finally,
everyones chemotherapy is individualized and can include one, two, or
more chemotherapy drugs provided at a treatment session- these different
treatments are decided because of someones diagnosis, age, any other
illnesses or conditions they may have (or comorbidities) and finally, based
upon peoples preferences. [2]

The next few pages outline some come chemotherapy agents that are used for managing Kaposi
Sarcoma, a great resource you may direct your patients to is: https://www.uptodate.com/contents/kaposi-
sarcoma-the-basics?source=see_link which outlines education on treatment, side effects, and lays out
the basics on why treatment causes side effects.

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Common Chemotherapy Agents Used to Manage Kaposi Sarcoma [2]

Therapy Category Dosing, Route and Absorption Side Effects Nursing Implications
- Know baseline CBC, especially platelet
and liver function tests test prior to cycle
- Note signs of radiation (redness, rash)
- Monitor dose toxicity
Fatigue, headache, chest - Obtain ECHO prior to mix with D5W
tightness and pain, skin rash, solution
Pegylated nausea, vomiting, diarrhea, - Can administer Benadryl for allergy-like
2
Liposomal - 50 mg/ m every 4 weeks edema, thrombocytopenia, symptoms
Doxorubicin weakness, back pain, - Be mindful of extravasation
(PLD) - Intravenous (IV) pharyngitis, cardiomyopathy, - IV rather than bolus to reduce
Antineoplastic
cardiotoxicity, ulcerations, cardiotoxicity
Agent
Polyethylene - Half Life: ~4.7 to 5.2 hours (this means hemorrhage, fever, chills, - Monitor for signs of hand-foot
glycol (PEG) that the drug will stay in your body lymphorrhea, hypersensitivity, syndrome
with actively for at least 9 to 10 hours) increase risk of hand-foot - BM monitoring
doxorubicin syndrome, esophagitis, high - Abdominal focused assessments for
proportion of gastrointestinal GIST
stomal tumor (GIST) - For patients with poorer performance
or extensive comorbidities
- Take caution with handling: use
hazardous drug handling considerations
- Review lab values prior to treatment
- Be mindful of extravasation
Angina pectoris, and - Obtain liver function tests
hypertension, depression of - Adjust dose according to ABC count
- 3.7 mg/m2 or 0.1mg/kg over an hour
- Antineoplastic CNS, headache, dizziness, - Monitor vitals (especially BP, and HR)
Vinblastine agent nausea, weakness, and - Note for signs of depression
- Adjust to account for a WBC count of
Sulfate metallic taste, alopecia, skin - Monitor neurological function
~3000/mm3 every 7 days
- Can be in rash, abdominal pain, - Note that if mixed with bleomycin the
(Velban, or combination anorexia, and stomatitis, risk for pulmonary toxicity increases with
- Can only be given Intravenous (IV)
Velsar) with bleomycin urinary retention, anemia, age >70 years and cumulative lifetime
(an antibiotic) myelosuppression, jaw pain, dose of >400 units
- Half-Life is ~25 hours
leukopenia (lower leukocyte - Take caution with handling- use
count), hair thinning hazardous drug handling considerations
- Review lab values prior to treatment

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- 135 mg/m2 over 3 hours every 3
weeks or 100 mg/m2 over 3 hours every
2 weeks
- Premedication with dexamethasone (20
mg orally at 12 and 6 hours prior to the
dose [reduce dexamethasone dose to 10
mg orally with advanced HIV disease]),
Antineoplastic diphenhydramine (50 mg IV 30 to 60
Paclitaxel
agent minutes prior to the dose), and
cimetidine, famotidine, or ranitidine (IV
30 to 60 minutes prior to the dose) is
recommended
- Intravenous (IV)
- ~13 to 20 hours over 3-hour infusion
- If protein-binding version then 80% to
98% absorption
- IV*: 50 to 100 mg/m2/day for 5 days
infused over a 30-60 minute period
minimum
*: do not dilute or push, contains alcohol
- Oral:100 to 200 mg/m2/day for 5 days;
administer daily doses >200 mg in 2
Antineoplastic
Etoposide divided doses.
Agent
- Bioavailability (PO): ~50% (range: 25%
to 75%)
- Half-life elimination on IV with normal
renal and hepatic function:
Children: 6 to 8 hours; Adults: 4 to 11
hours
Treatment Options for Classic Kaposi Sarcoma
Seline Tam, Aja Toste, Rita Vitorino, Yupeng Yan 2017
Edema, hypotension,
alopecia, nausea and
vomiting, neutropenia, risk of
infection, myalgia, and
weakness, dyspnea, allergic
reaction with taxane
Alopecia, nausea and
vomiting, abdominal pain,
anorexia, hypotension,
peripheral neuropathy,
hepatotoxicity, severe allergic
reactions, bronchospasm,
chills, dyspnea, fever,
tachycardia,
myelosuppression, may
cause amenorrhea, infertility
or premature menopause
KAPOSI SARCOMA
- Always use either conventional or
protein bound- the types are NOT
interchangeable
- Be mindful of extravasation
- Monitor for GI irritation
- Monitor for cardiovascular
abnormalities
- Be aware of allergic reaction with other
taxanes
-Take caution with handling- use
hazardous drug handling considerations
- Review lab values prior to treatment
- May be confused with teniposide,
etoposide phosphate or Versed
- High alert medication
- Take caution with handling- use
hazardous drug handling considerations
- Keep client warm to promote
circulation and reduce chills
- Monitor vitals
- Administer anti-emetics (prior, during,
and after treatments)
- Assess for lack of sensations in
peripheral limbs
- People with severe leukopenia,
thrombocytopenia, hypoalbiminemia,
hepatic impairment or renal impairment
should not take this medication
- Review lab values prior to treatment
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 KAPOSI SARCOMA

- 25 mg/m2 days 1 and 8 of a 21-day
treatment cycle (in combination with
gemcitabine) until disease progression or
unacceptable toxicity
- Navelbine: 10 mg/mL (1 mL); 50 mg/5
mL (5 mL) Fatigue, peripheral - Caution as Vinorelbine may be
- Granulocytes 1500 cells/mm3 on day neuropathy, nausea, confused with vinBLAStine, vinCRIStine
of treatment: Administer 100% of starting constipation, leukopenia, - Administration of this drug needs to be
dose. granulocytopenia, increased adjusted if a patient has hepatic
- Granulocytes 1000-1499 cells/mm3 on serum AST, site reaction, impairment
Vinorelbine
day of treatment: Administer 50% of includes bruising and vein - If Neurotoxicity grade 2: Discontinue
starting dose. discolouration, treatment
(Navelbine)
- Granulocytes <1000 cells/mm3 on day neuromuscular and skeletal - Monitor for extravasation as medication
of treatment: Do not administer. muscle weakness, localized is a vesicant
* In patients with concurrent hematologic phlebitis, chest pain, skin - Take caution with handling- use
toxicity and hepatic impairment, rash, sepsis , myalgia, jaw hazardous drug handling considerations
administer the lower of the doses pain, ototoxicity - Review lab values prior to treatment
- Intravenously only
- Distribution: Vd: binds extensively to
human platelets and lymphocytes (80%
to 91%)
- Half-life in Adults: 28 to 44 hours

- Take caution with handling- use

hazardous drug handling considerations
- Assess CBC levels (especially platelet
- Antineoplastic levels)
2
Gemcitabine Agent - Dose rate infusion (mg/m /min) - Monitor hepatic and renal functioning
Peripheral edema,
- Have - Intravenous (IV) - Monitor for fever, CNS changes, rash,
drowsiness, skin rash,
(Vinorelbine, response rates - With infusion times <70 minute, 42-94 GI upset, anemia, and dyspnea
nausea and vomiting,
Methotrexate, <20% as a minute half life - Monitor for infection
anemia, proteinuria, fever,
and single treatment - 3-4 hour infusions will have a half-life of - Should be treatment of choice if patient
dyspnea
Dacarbazine) and in 4-10.5 hours has clinical heart failure, or received
combination prior treatment with
2
>450 mg/m doxorubicin in the adjuvant
setting
- Review lab values prior to treatment

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Reference:
1. National Cancer Institute. (July 22, 2016). Kaposi Sarcoma Treatment (PDQ)- Patient Version.
Retrieved from https://www.cancer.gov/types/soft-tissue-sarcoma/patient/kaposi-treatment-
pdq#section/_50
2. Krown, S.E., and Singh, J.C. (March 30th, 2017). Classic Kaposi Sarcoma: Clinical features, staging,
diagnosis, and treatment. Retrieved from UptoDate [Accessed March 3rd, 2017]
3. Paredes, T. Pereira, M., Moreira, H. Simoes, M.R., and Canavarro, M.C. (2011). Quality of life of
sarcoma patients from diagnosis to treatments: predictors and longitudinal trajectories. European
Journal of Oncology Nursing, 15, 493-499.
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14th,2017 from
http://online.lexi.com.myaccess.library.utoronto.ca/lco/action/index/dataset/pdh_f.
5. American Society of Clinical Oncology. (December 2016). Proton Therapy. Retrieved from
http://www.cancer.net/navigating-cancer-care/how-cancer-treated/radiation-therapy/proton-
therapy
6. Cancer Treatment Centers of America. (2017). EBRT for soft tissue sarcoma. Retrieved from
http://www.cancercenter.com/soft-tissue-sarcoma/ebrt/
7. Cancer Treatment Centers of America. (2017). Pain management for soft tissue sarcoma. Retrieved
from http://www.cancercenter.com/soft-tissue-sarcoma/pain-management/
8. Bradley-Springer, L., Shaw, C.A, and Lewis, S.L. (2014). Infection and Human Immunodeficiency
Virus Infection. In Lewis, S.M, Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I. (2014).
Medical-surgical nursing in Canada: Assessment and management of clinical problems. (3rd ed.)
(M.A. Barry, S. Goldsworthy & D. Goodridge, Canadian Editors). Toronto: Elsevier Mosby.
9. Engelking, C., and Cady, J. (2014). Cancer. In Lewis, S.M, Dirksen, S., Heitkemper, M., Bucher, L.,
& Camera, I. (2014). Medical-surgical nursing in Canada: Assessment and management of
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Mosby.
10. Groopman J.E, Dezube B.J., and Ross M.E. (Dec 17, 2014). AIDS-related Kaposi sarcoma: Staging
and treatment. UpToDate [Accessed on March 3rd, 2017]
11. Rose, L.J., and Sparano, J.A. (April 16, 2015). Kaposi Sarcoma Treatment and Management.
Retrieved from http://emedicine.medscape.com/article/279734-treatment#d8
12. National Cancer Institute. (April 10, 2015). Complementary and Alternative Medicine. Retrieved from
https://www.cancer.gov/about-cancer/treatment/cam
13. Sarcoma Alliance. (2017). Complementary and Alternative Medicine. Retrieved from
http://sarcomaalliance.org/what-you-need-to-know/complimentary-therapies/
14. Andritsch, E., Beishon, M., Bielack, S., Bonvalot, S., Casali, P. Crul, M., Delgado-Bolton, R., Donati,
D.M., Douis, H., Haas, R., Hogendoorn, P., Kozhaeva, O., Lavender, V., Lovey, J., Negrouk, A.,
Pereira, P., Roca, P. Rochette de Lempdes, G., Saarto, T., van Berck, B., Vassel, G.,
Wartenberg, M., Yared, W., Costa, A., and Naredi, P. (2017). ECCO Essential Requirements for
Quality Cancer Care: Soft Tissue Sarcoma in Adults and Bone Sarcoma. A Critical Review.
Critical Reviews in Oncology/ Hematology, 110, 94-105.
15. Spears, J. (2008). Emotional support given by ward-based nurses to sarcoma patients. European
Journal of Oncology Nursing, 12, 334-341.

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