Document 0715
 DOCN  M94A0715
 TI    Clinical management of HIV-related malignancies.
 DT    9412
 AU    Volberding P; San Francisco General Hospital.
 SO    Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:23 (abstract no.
       FPI-3). Unique Identifier : AIDSLINE ASHM5/94348940
 AB    Two cancers are recognised as occurring in a higher rate in patients
       with HIV infection. These include non-Hodgkin's B cell lymphomas and
       Kaposi's sarcoma. In addition, some data indicates that Hodgkin's
       disease may also occur at an increased incidence. Many other
       malignancies have been reported in patients infected with HIV and the
       natural history of these malignancies may well be altered in the setting
       of a viral-induced immune deficiency. Kaposi's sarcoma remains the most
       common HIV-related malignancy, although its incidence is decreasing in
       all populations. Kaposi's sarcoma appears from epidemiologic evidence to
       be induced by a second pathogen in addition to HIV, although the nature
       of this probably enteric infection is unknown. The diagnosis of Kaposi's
       sarcoma ideally is made both visually and histologically as other
       conditions, especially bacillary angiomatosis can closely resemble this
       malignancy. Therapy for Kaposi's sarcoma is individualised. Slowly
       progressing disease may not require systemic treatment and local
       therapies can be used for facial lesions in particular. Systemic
       chemotherapy with vinca alkaloids is often used for early disease while
       more aggressive disease, especially involving the lungs, requires more
       aggressive combination chemotherapy, typically with combinations of
       adriamycin, bleomycin and vincristine. Newer biologic therapies are
       being developed. Non-Hodgkin's lymphomas in HIV infection occur at an
       increased rate and two main types of lymphomas are seen. These include
       central nervous system disease and peripheral non-Hodgkin's lymphomas.
       Central nervous systems lymphomas are essentially all EBV-related and
       occur in patients with severely depleted CD4 cell count. Peripheral
       lymphomas occur in patients with a more intact immune system and many
       are not EBV-associated. Peripheral B cell lymphomas in HIV are often
       extra nodal and disseminated and respond less completely to therapy than
       in the HIV uninfected patient. Aggressive chemotherapy is required
       although a bone marrow tolerance for aggressive chemotherapy is
       frequently dose-limiting. Therapy of HIV-related non-Hodgkin's lymphomas
       has been improved with the availability of bone marrow growth factor
       support, especially GCSF. The treatment of CNS lymphomas in HIV
       infection is, at best palliative. Radiation therapy is used, although
       survival is limited and response to therapy is often incomplete. Other
       malignancies in HIV infection, while not necessarily occurring at an
       increased incidence, have a more aggressive clinical course. The most
       important of these malignancies include cervical malignancies in women
       and anal squamous cell carcinomas in men. Routine cytologic examination
       for these cancers should be included in HIV management and these and
       other cancers should be treated as appropriate but considering the
       patient's disease stage.
 DE    Antineoplastic Agents, Combined/THERAPEUTIC USE  Anus Neoplasms/THERAPY
       Carcinoma, Squamous Cell/THERAPY  Cervix Neoplasms/THERAPY
       Chemotherapy, Adjuvant  Combined Modality Therapy  Female  Human  HIV
       Infections/*THERAPY  Lymphoma, AIDS-Related/THERAPY  Male
       Neoplasms/*THERAPY  Sarcoma, Kaposi's/THERAPY  Skin Neoplasms/THERAPY
       MEETING ABSTRACT

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