AIDS Related Kaposi Sarcoma Version 1 2019 October 19 2018 NCCN org NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Version 1 2019 10 19 18 National Comprehensive Cancer Network Inc 2018 All rights reserved The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN Continue Continue NCCN Guidelines Panel Disclosures NCCN Mary Dwyer MS Deborah Freedman Cass PhD Medical oncology Hematology Hematology oncology Radiotherapy Radiation oncology F Infectious diseases Surgery Surgical oncology Internal medicine Pathology Pharmacology Pharmacy Patient advocacy Discussion Writing Committee Member Lee Ratner MD PhD Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine Stacey Rizza MD F Mayo Clinic Cancer Center Michelle A Rudek PhD PharmD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Julian Sanchez MD Moffitt Cancer Center Jeff Taylor HIV Aging Research Project Palm Springs Benjamin Tomlinson MD Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Chia Ching J Wang MD UCSF Helen Diller Family Comprehensive Cancer Center Sai Yendamuri MD Roswell Park Comprehensive Cancer Center Allison Hall MD PhD Duke Cancer Institute Kimberly L Johung MD PhD Yale Cancer Center Smilow Cancer Hospital Ann Klopp MD PhD The University of Texas MD Anderson Cancer Center Ann S LaCasce MD Dana Farber Brigham and Women s Cancer Center Chi Lin MD Fred imaging is standard for staging of transplant associated KS cUseful in setting of clinical features ie fever dyspnea effusions concerning for KICS or KSHV associated MCD C reactive protein KSHV serum viral load SPEP IL 6 or IL 10 dSee Staging Classification for AIDS Related KS KS A AIDS RELATED KS STAGEd See First Line Therapy KS 2 Advanced cutaneous oral visceral or nodal disease See First Line Therapy KS 3 NCCN Guidelines Index Table of Contents Discussion Version 1 2019 10 19 18 National Comprehensive Cancer Network Inc 2018 All rights reserved The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Version 1 2019 AIDS Related Kaposi Sarcoma Note All recommendations are category 2A unless otherwise indicated Clinical Trials NCCN believes that the best management of any patient with cancer is in a clinical trial Participation in clinical trials is especially encouraged Printed by Maria Chen on 10 21 2018 10 50 05 PM For personal use only Not approved for distribution Copyright 2018 National Comprehensive Cancer Network Inc All Rights Reserved KS 2 Limited cutaneouse Symptomatic and or Cosmetically unacceptable Stable disease or Response Progressive disease Relapsed or progressive diseasel Limited cutaneous Advanced cutaneous oral visceral or nodal disease See KS 3 eSee Principles and Goals of Therapy KS B fInitiation of ART may result in immune reconstitution inflammatory syndrome IRIS within 3 6 months IRIS is characterized by marked lesional swelling increased tenderness and peripheral edema However ART should not be delayed or discontinued unless life threatening IRIS develops Reconstitution of immune function is important for obtaining and maintaining control or remission of KS gGlucocorticoids in any formulation should be avoided due to their association with KS progression However in cases of life threatening conditions including IRIS their use may be considered hSee clinicaltrials gov iSee Local Therapy KS C jSee Systemic Therapy KS D kSee Principles of Radiation Therapy KS E lIf after initial response to therapy KS relapses or progresses repeat use of previously effective therapy may be considered particularly if response was durable Asymptomatic and Cosmetically acceptable Antiretroviral therapy ART f g Clinical trialh or Topicalsi or Systemic therapyj or Intralesional chemotherapyi or RTe k or Local excision ARTf g and observe Symptomatic FIRST LINE THERAPYeRESPONSERELAPSED REFRACTORY THERAPY AIDS RELATED KS STAGE Continue ART and observe See Surveillance KS 4 NCCN Guidelines Index Table of Contents Discussion Version 1 2019 10 19 18 National Comprehensive Cancer Network Inc 2018 All rights reserved The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Version 1 2019 AIDS Related Kaposi Sarcoma Note All recommendations are category 2A unless otherwise indicated Clinical Trials NCCN believes that the best management of any patient with cancer is in a clinical trial Participation in clinical trials is especially encouraged Printed by Maria Chen on 10 21 2018 10 50 05 PM For personal use only Not approved for distribution Copyright 2018 National Comprehensive Cancer Network Inc All Rights Reserved KS 3 Advanced cutaneous oral visceral or nodal diseasee ARTf g Clinical trialh or Systemic therapyj Response Stable or progress