Kaposi’s sarcoma is a rare disease caused by the proliferation of vascular cells leading to the appearance of skin lesions that are more common in humans. It is associated with infection by the herpes virus. Insight with Prof. Céleste Lebbé, Head of the Skin Cancer Center of the Dermatology Department of the Saint-Louis Hospital in Paris.
Definition: What is sarcoma or Kaposi’s disease?
is Kaposi’s disease a rare disease that usually develops at skin level. “It is characterized by cell proliferation which resemble lymphoid cells and this proliferation is due to viral infection by a virus of the group herpesHerpes 8 (HHV-8)”, explains Professor Céleste Lebbé. The frequency of infection by the HHV-8 virus is heterogeneous worldwide: widespread in sub-Saharan Africa (more than 50% of the population were typically exposed to the virus during childhood) and in the countries around the Mediterranean basin, This viral infection is much less common in the West.
There are different forms of Kaposi:
- the classic kaposi which occurs in people who are generally older (Average age: 70) around the Mediterranean basin,
- the endemic Kaposi (Africa southern of the Sahara);
- the Kaposi epidemicassociated with HIV, occurring in younger people;
- iatrogenic Kapos (induced by drugs) in patients who have previously had organ transplants infected with HHV-8 and whose immunosuppressive treatment promotes reactivation of the virus.
What are the signs of sarcoma or Kaposi’s disease?
In the classic form, lesions on the extremities, especially feet and legs, predominate. Most often there is no itching.
Typically, Kaposi’s disease leads to skin marks : “Dermatologists are often the first line to make the diagnosis“. Symptoms can begin with lymphedemaie un swelling of a limb, usually a foot or legor by the appearance of skin lesions. “This disease can associate flat spots (spots), crimson (often mistaken for vein problems by non-dermatologists), raised lesions (papules or cupboards) always with you a red or purple colorand then, frankly, raised, raised lesions, like “balls” that are called lump. All of this can be connected in the same person“, specifies Professor Lebbé. In the classic form, the lesions predominate at the level of the extremities, especially the feet and legs. Most of the time there is no itching. Sometimes the lesions can ulcerate and become painful.”The aesthetic discomfort varies according to the number and shape of the lesions and, in particular, according to the patient’s age. The mucous membranes are more frequently affected in HIV-associated forms, or iatrogenic. Involvement of the mouth is often indicative of digestive system involvement. “The incidence and severity of HIV-associated Kaposi’s disease has decreased significantly since 1995 thanks to antiretroviral treatment (treatments that allow HIV infection to be controlled)” adds Professor Lebbe.
While 10-20% of Mediterranean people and more than 50% of Africans are infected with this virus, only a small proportion develop Kaposi’s disease.
How is the virus of a sarcoma or Kaposi’s disease transmitted?
Herpesvirus 8 (HHV-8) causes Kaposi’s disease. However, if 10-20% of Mediterranean people and more than 50% of Africans are infected with this virus, only a small proportion will develop Kaposi’s disease. This means that there are other factors that influence the occurrence of the disease, these are still unknown. Transmission of the HHV-8 virus occurs primarily through:
- close contacts, typically within siblings,
- sexual way.
Diagnosis of Kaposi’s disease is made by Biopsy of a skin lesion : The pathologist analyzes the samples and identifies the antigens of the HHV-8 virus. The results are fast (within a few days).
What is the treatment for sarcoma or Kaposi’s disease?
The treatment of Kaposi varies depending on whether the patient is immunosuppressed or not. Treatment of Kaposi’s disease is mainly based on Screening for possible HIV infection ; Serology is, of course, obligatory after the patient has been informed and consented to.
► With HIV infection: Treatment is based on management by specialized teams beginning with a Combination of antiretroviral drugspossibly in connection with the severity and the patient’s embarrassment with specific local or general treatments of Kaposi. “In this case, the key to long-term success is management of HIV infection”.
► At aThe endemic or classic Kaposi, treatment depends on the extent, progression of the lesions, the patient’s symptoms and general condition. Therefore, simple monitoring may be recommended in some patients: “We will not necessarily treat an 80-year-old man. It is not because we remove one lesion that we will prevent other lesions from occurring.” ; in other patients, so-called local treatment can be considered. Depending on the type of lesions, we can offer both Surgery, either radiation therapy, dye laser, or retinoid creams. Another local treatment is currently being evaluated at Saint-Louis Hospital.”We have developed a research protocol that evaluates the effectiveness of a type of vaccine injected into the lesions, with interesting results.”
► In the more diffuse or frankly progressive forms We will block the flare with general systemic treatments: short-term chemotherapy of less than 6 months, immunotherapy with low-dose interferon. “We have in Saint-Louis with Dr. Julie Delyon developed a therapeutic study on anti-PD1 antibodies, a new form of immunotherapy in which we try to stimulate anti-tumor lymphocytes. The preliminary results are remarkable but need to be confirmed before considering a possible market approval”, She adds.
In general, Kaposi is not a fatal disease, it can lie dormant for months or years
Can sarcoma or Kaposi’s disease be completely cured?
Classic or endemic Kaposi’s disease is a chronic disease cyclical development : “In general, Kaposi is not a fatal disease, it can lie dormant for months or years. The treatment is not curative: in the hospital we tend to see patients with severe and chronic courses where we can treat relapses effectively.. If Kaposi’s disease occurs in the context of HIV infection, we can observe a very prolonged remission 1-2 years after starting antiretroviral treatment. It’s like healing. “This is possible thanks to the patience and observation of the patient. In severe forms of the disease, antiretroviral treatment can sometimes be accompanied by chemotherapy.
Thanks to Pr Céleste Lebbé, Head of the Skin Cancer Center, Dermatology Department, Saint-Louis Hospital, AP-HP North Cancer Institute, Paris-Cité University.
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