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Case Report/Case Series |

Clinical Activity of Lenalidomide in Visceral Human Immunodeficiency Virus–Related Kaposi Sarcoma

Maud Steff, MD1,2; Véronique Joly, MD, PhD2,3; Julie Di Lucca, MD1,2; Judith Feldman, MD2,4; Samuel Burg, MD2,5; Laure Sarda-Mantel, MD2,5; Gilles Peytavin, MD, PhD6; Eduardo Marinho, MD2,7; Béatrice Crickx, MD, PhD1,2; Eric Raymond, MD, PhD2,8; Sylvie Lariven, MD2,3; Eve Maubec, MD1,2
[+] Author Affiliations
1Service de Dermatologie, Hôpital Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
2Université Paris Diderot Sorbonne Paris Cité, Paris, France
3Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
4Service de Médecine Interne, Hôpital Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
5Service de Médecine Nucléaire, Hôpital Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
6Service de Pharmacie, Hôpital Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
7Service d’Anatomie et Cytologie Pathologiques, Hôpital Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
8Service d’Oncologie Médicale, Hôpital Beaujon-Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
JAMA Dermatol. 2013;149(11):1319-1322. doi:10.1001/jamadermatol.2013.5751.
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Importance  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.

Observations  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.

Conclusions and Relevance  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.

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Figures

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Figure 1.
Gangrene Extension After Conventional Chemotherapy

After 2 lines of conventional chemotherapy, the gangrene extended to all left toes, with leg and foot ulcers causing life-threatening bleeding.

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Figure 2.
Positron-Emission Tomography With Computed Tomography (PET/CT) Scan Before LenalidomideTreatment

Before treatment with lenalidomide, a PET/CT scan showed visceral extent of the Kaposi sarcoma, with diffuse bone marrow, lymph node, lung, hepatic, and pancreatic metastases.

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Figure 3.
Positron-Emission Tomography With Computed Tomography (PET/CT) Scan After Lenalidomide Treatment

After 2 cycles of lenalidomide, PET/CT scan evaluation showed a partial response with major reduction of hypermetabolic abnormalities, especially disappearance of lung, hepatic, and pancreatic lesions.

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