Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in Kenya
Abstract Background Kaposi’s sarcoma (KS) is one of the most common HIV-associated malignancies in sub-Saharan Africa. Worldwide, the availability of antiretroviral therapy (ART) has improved KS survival. In resource-rich settings, survival has also benefited from chemotherapy, which is widely avail...
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doaj-d48bd70809e94f2eba78c04d29e201712021-01-31T16:38:38ZengBMCBMC Cancer1471-24072020-01-0120111110.1186/s12885-019-6506-3Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in KenyaEsther E. Freeman0Naftali Busakhala1Susan Regan2Fredrick Chite Asirwa3Megan Wenger4Divya Seth5Khatiya Chelidze Moon6Aggrey Semeere7Toby Maurer8Kara Wools-Kaloustian9Ingrid Bassett10Jeffrey Martin11Department of Dermatology, Massachusetts General Hospital, Harvard Medical SchoolAMPATH, Moi UniversityDepartment of Dermatology, Massachusetts General Hospital, Harvard Medical SchoolAMPATH, Moi UniversityUniversity of CaliforniaDepartment of Dermatology, Massachusetts General Hospital, Harvard Medical SchoolDepartment of Dermatology, Massachusetts General Hospital, Harvard Medical SchoolUniversity of CaliforniaUniversity of CaliforniaIndiana UniversityDepartment of Dermatology, Massachusetts General Hospital, Harvard Medical SchoolUniversity of CaliforniaAbstract Background Kaposi’s sarcoma (KS) is one of the most common HIV-associated malignancies in sub-Saharan Africa. Worldwide, the availability of antiretroviral therapy (ART) has improved KS survival. In resource-rich settings, survival has also benefited from chemotherapy, which is widely available. Little is known, however, about the epidemiology of chemotherapy use for HIV-associated KS in resource-limited regions such as sub-Saharan Africa. Methods We identified all patients newly diagnosed with HIV-related KS from 2009 to 2012 in the 26-clinic AMPATH network, a large community-based care network in Kenya. We ascertained disease severity at diagnosis, frequency of initiation of chemotherapy, and distribution of chemotherapeutic regimens used. Indications for chemotherapy included AIDS Clinical Trial Group T1 stage and/or “severe” disease defined by WHO KS treatment guidelines. Results Of 674 patients diagnosed with KS, charts were available for 588; 61% were men, median age was 35 years, and median CD4 at KS diagnosis was 185 cells/μl. At time of diagnosis, 58% had at least one chemotherapy indication, and 22% had more than one indication. For patients with a chemotherapy indication, cumulative incidence of chemotherapy initiation (with death as a competing event) was 37% by 1 month and 56% by 1 year. Median time from diagnosis to chemotherapy initiation was 25 days (IQR 1–50 days). In multivariable regression, patients with > 3 chemotherapy indications at time of diagnosis had a 2.30 (95% CI 1.46–3.60) increased risk of rapid chemotherapy initiation (within 30 days of diagnosis) compared to those with only one chemotherapy indication (p < 0.001). Initial regimens were bleomycin-vincristine (78%), adriamycin-bleomycin-vincristine (11%), etoposide (7%), and gemcitabine (4%). Conclusions A substantial fraction of patients with KS in East Africa are diagnosed at advanced disease stage. For patients with chemotherapy indications, nearly half did not receive chemotherapy by one year. Liposomal anthracyclines, often used in resource-rich settings, were not first line. These findings emphasize challenges in East Africa cancer care, and highlight the need for further advocacy for improved access to higher quality chemotherapy in this setting.https://doi.org/10.1186/s12885-019-6506-3Kaposi’s sarcomaHIV-associated malignancyChemotherapyCancer care |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Esther E. Freeman Naftali Busakhala Susan Regan Fredrick Chite Asirwa Megan Wenger Divya Seth Khatiya Chelidze Moon Aggrey Semeere Toby Maurer Kara Wools-Kaloustian Ingrid Bassett Jeffrey Martin |
spellingShingle |
Esther E. Freeman Naftali Busakhala Susan Regan Fredrick Chite Asirwa Megan Wenger Divya Seth Khatiya Chelidze Moon Aggrey Semeere Toby Maurer Kara Wools-Kaloustian Ingrid Bassett Jeffrey Martin Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in Kenya BMC Cancer Kaposi’s sarcoma HIV-associated malignancy Chemotherapy Cancer care |
author_facet |
Esther E. Freeman Naftali Busakhala Susan Regan Fredrick Chite Asirwa Megan Wenger Divya Seth Khatiya Chelidze Moon Aggrey Semeere Toby Maurer Kara Wools-Kaloustian Ingrid Bassett Jeffrey Martin |
author_sort |
Esther E. Freeman |
title |
Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in Kenya |
title_short |
Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in Kenya |
title_full |
Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in Kenya |
title_fullStr |
Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in Kenya |
title_full_unstemmed |
Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in Kenya |
title_sort |
real-world use of chemotherapy for kaposi’s sarcoma in a large community-based hiv primary care system in kenya |
publisher |
BMC |
series |
BMC Cancer |
issn |
1471-2407 |
publishDate |
2020-01-01 |
description |
Abstract Background Kaposi’s sarcoma (KS) is one of the most common HIV-associated malignancies in sub-Saharan Africa. Worldwide, the availability of antiretroviral therapy (ART) has improved KS survival. In resource-rich settings, survival has also benefited from chemotherapy, which is widely available. Little is known, however, about the epidemiology of chemotherapy use for HIV-associated KS in resource-limited regions such as sub-Saharan Africa. Methods We identified all patients newly diagnosed with HIV-related KS from 2009 to 2012 in the 26-clinic AMPATH network, a large community-based care network in Kenya. We ascertained disease severity at diagnosis, frequency of initiation of chemotherapy, and distribution of chemotherapeutic regimens used. Indications for chemotherapy included AIDS Clinical Trial Group T1 stage and/or “severe” disease defined by WHO KS treatment guidelines. Results Of 674 patients diagnosed with KS, charts were available for 588; 61% were men, median age was 35 years, and median CD4 at KS diagnosis was 185 cells/μl. At time of diagnosis, 58% had at least one chemotherapy indication, and 22% had more than one indication. For patients with a chemotherapy indication, cumulative incidence of chemotherapy initiation (with death as a competing event) was 37% by 1 month and 56% by 1 year. Median time from diagnosis to chemotherapy initiation was 25 days (IQR 1–50 days). In multivariable regression, patients with > 3 chemotherapy indications at time of diagnosis had a 2.30 (95% CI 1.46–3.60) increased risk of rapid chemotherapy initiation (within 30 days of diagnosis) compared to those with only one chemotherapy indication (p < 0.001). Initial regimens were bleomycin-vincristine (78%), adriamycin-bleomycin-vincristine (11%), etoposide (7%), and gemcitabine (4%). Conclusions A substantial fraction of patients with KS in East Africa are diagnosed at advanced disease stage. For patients with chemotherapy indications, nearly half did not receive chemotherapy by one year. Liposomal anthracyclines, often used in resource-rich settings, were not first line. These findings emphasize challenges in East Africa cancer care, and highlight the need for further advocacy for improved access to higher quality chemotherapy in this setting. |
topic |
Kaposi’s sarcoma HIV-associated malignancy Chemotherapy Cancer care |
url |
https://doi.org/10.1186/s12885-019-6506-3 |
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