Abstract 4873

Introduction:

Kaposi's sarcoma (KS) is a low-grade HHV-8 associated vascular tumor that is particularly prevalent in patients infected with HIV. The mainstay of treatment is HAART, which has decreased the aggressiveness, and possibly the prevalence of this disease. Cytotoxic chemotherapy is generally added for moderate to severe symptomatic disease, with Pegylated Liposomal Doxorubicin (Doxil) being the treatment of choice. Studies have shown that unlike regular anthracyclines, Doxil can be safely administered over long periods at low doses without inducing cardio toxicity. The present study was done to evaluate cardiac toxicity associated with prolonged administration of Doxil in patients with KS.

Methods:

Seven-year retrospective chart review of 55 KS patients treated with 20mg/m2 of Doxil every 3 weeks until disappearance of lesions, withdrawal or change of treatment, or discovery of cardiac damage by annual MUGA scans. All patients received HAART concomitantly. In general, compliance was good. All presenting patients were male with one genetic male transsexual.

Results:

The median age of patients was 40 years; range between 25 – 56 years.

Table 1:

Demographics

EthnicityNumberPercentage
Black non-Hispanic 32 58.2 
White non-Hispanic 13 23.6 
Hispanic 8 14.5 
Asian 2 3.6 
Total 55 100 
EthnicityNumberPercentage
Black non-Hispanic 32 58.2 
White non-Hispanic 13 23.6 
Hispanic 8 14.5 
Asian 2 3.6 
Total 55 100 
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Table 2:

Grouping of patients by cumulative dose of Doxil received

Cumulative doseNumber of patients
< 200mg/m2 21 
200-399mg/m2 11 
400-500mg/m2 7 
Over 500mg/m2 16 
Total 55 
Cumulative doseNumber of patients
< 200mg/m2 21 
200-399mg/m2 11 
400-500mg/m2 7 
Over 500mg/m2 16 
Total 55 
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5 patients died during the study; 3 due to infectious complications and 2 due to heart disease. 7 patients had to discontinue Doxil when LVEF decreased to < 50%. Of the 16 patients who received >500mg/m2 Doxil, 1 died of cancer and 3 were switched to other drugs due to low LVEF. 1 of these 3 patients with decreased LVEF had a severely abnormal MUGA which then led to the diagnosis of coronary artery disease. The other 12 in this subgroup remain alive with no evidence of heart disease.

Conclusion:

In concordance with prior studies, our study shows that patients can tolerate greater than 500mg/m2 of cumulative Doxil dose, while being monitored closely with physical examination and MUGA scans. Obtaining MUGA scans every 6 months, instead of annually as was done in our study, may lead to earlier recognition of cardiotoxicity.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
doxorubicin, hiv infections, kaposi sarcoma, liposomes, safety-net hospitals, gated blood-pool imaging, antiretroviral therapy, highly active, cardiotoxicity, heart diseases, anthracycline antibiotics

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2010 by The American Society of Hematology
2010
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