Document Detail

Kaposi's sarcoma responding to topical imiquimod 5% cream: a case report.
Jump to Full Text
MedLine Citation:
PMID:  20181188     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Kaposi's sarcoma, a virus-associated neoplasm, can be treated with systemic therapy such interferon or chemotherapy, although a local alternative is possible in localized disease.Topical imiquimod is a ligand of the toll-like receptors 7 and 8 on dendritic cells, increasing immune responses and showing antiviral and antitumoral activities. We report a spectacular response to imiquimod 5% cream in a patient with classic Kaposi's sarcoma of the leg.
Authors:
Sophia Benomar; Saber Boutayeb; Leila Benzekri; Hassan Errihani; Badreddine Hassam
Related Documents :
7000348 - Results of the royal marsden hospital second soft tissue sarcoma schedule (sts ii) chem...
22516388 - Normal tissue complication probability analysis of acute gastrointestinal toxicity in c...
22802748 - Preoperative concurrent chemoradiotherapy for locally advanced rectal cancer: treatment...
22300468 - Management of hcc.
22372738 - Heterogeneous nuclear ribonucleoprotein a2/b1 in association with htert is a potential ...
7000348 - Results of the royal marsden hospital second soft tissue sarcoma schedule (sts ii) chem...
Publication Detail:
Type:  Journal Article     Date:  2009-09-17
Journal Detail:
Title:  Cases journal     Volume:  2     ISSN:  1757-1626     ISO Abbreviation:  Cases J     Publication Date:  2009  
Date Detail:
Created Date:  2010-02-25     Completed Date:  2010-07-15     Revised Date:  2010-09-30    
Medline Journal Info:
Nlm Unique ID:  101474272     Medline TA:  Cases J     Country:  England    
Other Details:
Languages:  eng     Pagination:  7092     Citation Subset:  -    
Affiliation:
Department of Dermatology, Ibn Sina Hospital, Rabat, Morocco. Sophia.boutayeb@yahoo.fr
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Cases J
ISSN: 1757-1626
Publisher: BioMed Central
Article Information
Download PDF
Copyright ?2009 Benomar et al.; licensee Cases Network Ltd. licensee BioMed Central Ltd.
open-access:
Received Day: 6 Month: 4 Year: 2009
Accepted Day: 13 Month: 8 Year: 2009
collection publication date: Year: 2009
Electronic publication date: Day: 17 Month: 9 Year: 2009
Volume: 2First Page: 7092 Last Page: 7092
ID: 2827081
PubMed Id: 20181188
Publisher Id: 1757-1626-0002-0000007092
DOI: 10.4076/1757-1626-2-7092

Kaposi's sarcoma responding to topical imiquimod 5% cream: a case report
Sophia Benomar1 Email: Sophia.boutayeb@yahoo.fr
Saber Boutayeb2 Email: boutayebdr@yahoo.fr
Leila Benzekri1 Email: lbenzekri2005@yahoo.fr
Hassan Errihani2 Email: herrihani@yahoo.fr
Badreddine Hassam1 Email: hassambadr@gmail.com
1Department of Dermatology, Ibn Sina hospital, Rabat, Morocco
2Department of Medical Oncology, National Oncology Institute, Rabat, Morocco

Introduction

Kaposi's sarcoma (KS) is a vascular neoplasm with four clinical subtypes: classic, African immunosuppression-associated and AIDS-related. All variants have been related to the eighth human herpes virus (HHV8) [1].

Interferon alpha was used at high dose in AIDS-related KS and low-dose in classic and endemic KS [2]. Therefore, topical imiquimod, an immune response modifier with antiangiogenic properties able to induce interferon-alpha secretion in situ, could prove a good local treatment for KS skin lesions [3].


Case presentation

A 57-year-old HIV negative Mediterranean man was treated with imiquimod 5% cream for purple maculo-papular cutaneous lesions on the leg that were histologically consistent with KS (papillary dermal proliferation of small angulated vessels lined by bland endothelial cells with an accompanying sparse infiltrate of lymphocytes and plasma cells).

The treatment protocol consisted of 3 weekly applications (Monday, Thursday, Saturday) under occlusion for at least 10 hours (between 10 and 12 hours). During the first week, the three applications were applied by the patient under supervision then the cream was self-administered for the following applications. The tolerance was good with no side effects. After twenty weeks, the purple maculo-papular lesions cleared (complete clinical response). Six months later the patient is still disease free.


Discussion

Imiquimod 5% cream is a topically active immune response modifier approved as a treatment for actinic keratosis, superficial basal cell carcinoma, and external genital warts. [4] The drug up-regulates cytokine production, such as alpha-interferon, tumor necrosis factor alpha and promotes a T-helper type 1 cell-mediated immune response. Adverse events reported with imiquimod treatment include local side effects at the application site, ranging from mild erythema to weeping, crusting, and erosions. Systemic side effects are exceptional [5].

Concerning the literature, there are only two cases reports of KS treated by imiquimod and one phase II study. In the first report, the KS was AIDS-related whereas the second was a classic Kaposi's sarcoma [6,7].

In this last report, the patient was treated for classic Kaposi's sarcoma of both legs with imiquimod 5% cream once daily after progression under etoposide at the dose of 50 mg/day. After one year of therapy a complete response was observed and confirmed according to histopathology and immunohistochemistry.

The treatment was well tolerated, and the only significant side effects were flu-like symptoms that disappeared with the reduction of the dosage. After more than one year of follow-up, the patient was still disease-free. The tolerance was good with only transient itching and flu-like symptoms.

The phase II trial was conducted by a French team, and 17 patients were enrolled for classic or endemic KS. The treatment by imiquimod 5% cream was applied under occlusion three times per week for 24 weeks. Eight patients (47%) presented objective overall clinical response (2 complete and 6 partial responses). Tumor progression was noted in 6 patients. The most frequent side effects were local itching and erythema, seen in 9 patients (53%) [8].

For all the patients, there were no clinically meaningful changes from baseline in any of the laboratory test values, physical examinations, or vital sign measurements during the course of the study. There were no treatment-related deaths or serious adverse events.

Immunocompetent patients with new and small skin lesions seem to be ideal patients for treatment by topical imiquimod. Imiquimod cream offers an attractive alternative to locally destructive therapies, with less risk of pain, ulceration, and residual scarring. Furthermore, imiquimod can be applied by the patient.


Conclusion

Topical imiquimod seems to be a good local treatment for Kaposi's sarcoma skin lesions with a good toxicity profile, regimens with daily application may offer best clinical results and should be explored and evaluated concerning the toxicity.


Consent

Written informed consent was obtained from the patient for the publication of this case. A copy of the written consent is available for review by the Editor-in-Chief of this journal.


Competing interests

The authors have indicated no significant interest with commercial supporters.


Authors' contributions

SB and BS interpreted the patient data regarding the disease history and contributed to the literature research. BL and BH and HE contributed to the treatment of the disease and reviewed the manuscript.


References
Morand JJ,Lightburn E,Simon F,Patte JH,Update on Kaposi's sarcomaMed Trop (Mars)Year: 20076712313017691428
Di lorenzo G,Update on classic Kaposi sarcoma therapy: New look at an old diseaseCrit Rev Oncol HematolYear: 20086824224910.1016/j.critrevonc.2008.06.00718657433
Sauder DN,Immunomodulatory and pharmacologic properties of imiquimodJ Am Acad DermatoYear: 200043S6S1110.1067/mjd.2000.10780810861101
Beutner KR,Spruance SL,Hougham AJ,Fox TL,Owens ML,Douglas JM Jr,Treatment of genital warts with an immune response modifier (imiquimod)J Am Acad DermatolYear: 19983823023910.1016/S0190-9622(98)70243-99486679
Hadley G,Derry S,Moore RA,Imiquimod for actinic keratosis: systematic review and meta-analysisJ Invest DermatolYear: 20061261251125510.1038/sj.jid.570026416557235
Rosen T,Limited extent AIDS-related cutaneous Kaposi's sarcoma responsive to imiquimod 5% creamInt J DermatolYear: 20064585485610.1111/j.1365-4632.2006.02829.x16863526
Goiriz R,Rios-Buceta L,Gonzales De Arriba A,Aragues M,Garcia diez A,Treatment of Classic Kaposi's Sarcoma with Topical ImiquimodDermatol SurgYear: 20093514714910.1111/j.1524-4725.2008.34397.x19076206
Celestin Schartz NE,Chevret S,Paz C,Kerob D,Verola O,Morel P,Lebbe C,Imiquimod 5% cream for treatment of HIV-negative Kaposi's sarcoma skin lesions: a phase I to II, open-label trial in 17 patientsJ Am Acad DermatolYear: 20085858559118068265

Article Categories:
  • Research article


Previous Document:  Acute aortic dissection in a young patient without Marfan fibrillinopathy: a case report.
Next Document:  Normalization of systemic arterial hypertension following removal of posterior fossa hemangioblastom...