Neither single-agent
therapy nor any combination treatment has been satisfactory enough to be regarded as standard in systemic advanced
Kaposi sarcoma. In an attempt to achieve high efficacy in combination with low toxicity, we used a new liposomal formulation of
doxorubicin. Pharmacologic data had established a long plasma half-life, an increased accumulation in
tumor tissue, and a decrease in uptake by tissues such as liver, spleen, and bone marrow. In a phase I/II open-label, dose-escalating trial 40 male
AIDS patients with advanced
Kaposi sarcoma were enrolled to receive intravenous "stealth"
liposomal doxorubicin biweekly at doses of 10 mg/m2 (n = 10), 20 mg/m2 (n = 27), and 40 mg/m2 (n = 3). The median CD4 count at baseline was 25/microL. After six cycles (12 weeks), 39 patients were evaluable. Three patients (7.5%) showed a complete response, which was histologically confirmed. A partial response was documented in 33 patients (85%). Stable disease was observed in three patients (7.5%). During a median
treatment duration of 25 weeks, four patients developed
stomatitis (10%), and four patients (10%) experienced
alopecia. The most frequent hematologic toxicity was
neutropenia. Grade 4
neutropenia was seen in 42.5%, and grade 3 toxicity was seen in 30%. Toxicity was dose-dependent and more frequent in the 40 mg/m2 stratum. During a median observation period of 25 weeks,
opportunistic infections occurred in 57.5% of the patient population. We conclude that
liposomal doxorubicin at dose levels of 10 and 20 mg/m2 is safe and effective for treatment of advanced
Kaposi sarcoma in
AIDS. A controlled trial comparing
liposomal doxorubicin to conventional combination
therapy is underway.