Triple therapy of vincristine, bleomycin and etoposide for children with Kaposi sarcoma: Results of a study in Malawian children

Marita Macken, Helen Dale, Dominic Moyo, Eunice Chakmata, Sarita Depani, Trijn Israels, Dalida Niyrenda, Simon Bailey, George Chagaluka, Elizabeth M. Molyneux

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Kaposi sarcoma (KS) is the most common paediatric cancer in human immunodeficiency virus (HIV) endemic countries of sub-Saharan Africa, but there is little research on management and outcomes. Methods: Children with KS at Queen Elizabeth Central Hospital, Blantyre, Malawi treated between August 2012 and March 2015 with six courses of vincristine, bleomycin and etoposide combination chemotherapy, including antiretroviral therapy (ART) if HIV infected, were studied and outcomes compared with previously reported results. Findings: Fifty-six children were included; 38 (68%) were male; and 48 (86%) were HIV positive, of whom 36 (77%) were on ART at diagnosis. Median age at diagnosis was 8 years (interquartile range [IQR] 3–12) and median follow-up was 16.9 months (IQR 3.4–36.4). Quality of life improved in 45 (80%) children; the median Lansky Score increased from 80% pre-treatment to 100% post-treatment. Eighteen (32%) children had complete response to treatment. At 12 months, overall survival was 71% (95% confidence interval [CI] 56–82) and event-free survival (event = death, loss to follow-up or relapse) was 50% (95% CI 36–63). At 1 year, the risk of loss to follow-up was 13.4%. In a previous, same-site, randomized controlled study of vincristine monotherapy, vincristine and bleomycin, or oral etoposide, oral etoposide monotherapy had the best outcome with survival at 12 month of 66% (95% CI 46–80) and event-free survival of 52% (95% CI 33–68); however, loss to follow-up was not reported. Conclusion: Overall survival, event-free survival and quality of life appear to have improved with this three-agent combination chemotherapy; however larger, randomized studies are needed to determine optimal management.
Original languageEnglish
Article numbere26841
JournalPediatric Blood and Cancer
Volume65
Issue number2
DOIs
Publication statusPublished - 2018
Externally publishedYes

Cite this

Macken, Marita ; Dale, Helen ; Moyo, Dominic ; Chakmata, Eunice ; Depani, Sarita ; Israels, Trijn ; Niyrenda, Dalida ; Bailey, Simon ; Chagaluka, George ; Molyneux, Elizabeth M. / Triple therapy of vincristine, bleomycin and etoposide for children with Kaposi sarcoma: Results of a study in Malawian children. In: Pediatric Blood and Cancer. 2018 ; Vol. 65, No. 2.
@article{5cac4ce552d7492bb3a09960c8d161cf,
title = "Triple therapy of vincristine, bleomycin and etoposide for children with Kaposi sarcoma: Results of a study in Malawian children",
abstract = "Background: Kaposi sarcoma (KS) is the most common paediatric cancer in human immunodeficiency virus (HIV) endemic countries of sub-Saharan Africa, but there is little research on management and outcomes. Methods: Children with KS at Queen Elizabeth Central Hospital, Blantyre, Malawi treated between August 2012 and March 2015 with six courses of vincristine, bleomycin and etoposide combination chemotherapy, including antiretroviral therapy (ART) if HIV infected, were studied and outcomes compared with previously reported results. Findings: Fifty-six children were included; 38 (68{\%}) were male; and 48 (86{\%}) were HIV positive, of whom 36 (77{\%}) were on ART at diagnosis. Median age at diagnosis was 8 years (interquartile range [IQR] 3–12) and median follow-up was 16.9 months (IQR 3.4–36.4). Quality of life improved in 45 (80{\%}) children; the median Lansky Score increased from 80{\%} pre-treatment to 100{\%} post-treatment. Eighteen (32{\%}) children had complete response to treatment. At 12 months, overall survival was 71{\%} (95{\%} confidence interval [CI] 56–82) and event-free survival (event = death, loss to follow-up or relapse) was 50{\%} (95{\%} CI 36–63). At 1 year, the risk of loss to follow-up was 13.4{\%}. In a previous, same-site, randomized controlled study of vincristine monotherapy, vincristine and bleomycin, or oral etoposide, oral etoposide monotherapy had the best outcome with survival at 12 month of 66{\%} (95{\%} CI 46–80) and event-free survival of 52{\%} (95{\%} CI 33–68); however, loss to follow-up was not reported. Conclusion: Overall survival, event-free survival and quality of life appear to have improved with this three-agent combination chemotherapy; however larger, randomized studies are needed to determine optimal management.",
author = "Marita Macken and Helen Dale and Dominic Moyo and Eunice Chakmata and Sarita Depani and Trijn Israels and Dalida Niyrenda and Simon Bailey and George Chagaluka and Molyneux, {Elizabeth M.}",
year = "2018",
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journal = "Pediatric Blood and Cancer",
issn = "1545-5009",
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Macken, M, Dale, H, Moyo, D, Chakmata, E, Depani, S, Israels, T, Niyrenda, D, Bailey, S, Chagaluka, G & Molyneux, EM 2018, 'Triple therapy of vincristine, bleomycin and etoposide for children with Kaposi sarcoma: Results of a study in Malawian children' Pediatric Blood and Cancer, vol. 65, no. 2, e26841. https://doi.org/10.1002/pbc.26841

Triple therapy of vincristine, bleomycin and etoposide for children with Kaposi sarcoma: Results of a study in Malawian children. / Macken, Marita; Dale, Helen; Moyo, Dominic; Chakmata, Eunice; Depani, Sarita; Israels, Trijn; Niyrenda, Dalida; Bailey, Simon; Chagaluka, George; Molyneux, Elizabeth M.

In: Pediatric Blood and Cancer, Vol. 65, No. 2, e26841, 2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Triple therapy of vincristine, bleomycin and etoposide for children with Kaposi sarcoma: Results of a study in Malawian children

AU - Macken, Marita

AU - Dale, Helen

AU - Moyo, Dominic

AU - Chakmata, Eunice

AU - Depani, Sarita

AU - Israels, Trijn

AU - Niyrenda, Dalida

AU - Bailey, Simon

AU - Chagaluka, George

AU - Molyneux, Elizabeth M.

PY - 2018

Y1 - 2018

N2 - Background: Kaposi sarcoma (KS) is the most common paediatric cancer in human immunodeficiency virus (HIV) endemic countries of sub-Saharan Africa, but there is little research on management and outcomes. Methods: Children with KS at Queen Elizabeth Central Hospital, Blantyre, Malawi treated between August 2012 and March 2015 with six courses of vincristine, bleomycin and etoposide combination chemotherapy, including antiretroviral therapy (ART) if HIV infected, were studied and outcomes compared with previously reported results. Findings: Fifty-six children were included; 38 (68%) were male; and 48 (86%) were HIV positive, of whom 36 (77%) were on ART at diagnosis. Median age at diagnosis was 8 years (interquartile range [IQR] 3–12) and median follow-up was 16.9 months (IQR 3.4–36.4). Quality of life improved in 45 (80%) children; the median Lansky Score increased from 80% pre-treatment to 100% post-treatment. Eighteen (32%) children had complete response to treatment. At 12 months, overall survival was 71% (95% confidence interval [CI] 56–82) and event-free survival (event = death, loss to follow-up or relapse) was 50% (95% CI 36–63). At 1 year, the risk of loss to follow-up was 13.4%. In a previous, same-site, randomized controlled study of vincristine monotherapy, vincristine and bleomycin, or oral etoposide, oral etoposide monotherapy had the best outcome with survival at 12 month of 66% (95% CI 46–80) and event-free survival of 52% (95% CI 33–68); however, loss to follow-up was not reported. Conclusion: Overall survival, event-free survival and quality of life appear to have improved with this three-agent combination chemotherapy; however larger, randomized studies are needed to determine optimal management.

AB - Background: Kaposi sarcoma (KS) is the most common paediatric cancer in human immunodeficiency virus (HIV) endemic countries of sub-Saharan Africa, but there is little research on management and outcomes. Methods: Children with KS at Queen Elizabeth Central Hospital, Blantyre, Malawi treated between August 2012 and March 2015 with six courses of vincristine, bleomycin and etoposide combination chemotherapy, including antiretroviral therapy (ART) if HIV infected, were studied and outcomes compared with previously reported results. Findings: Fifty-six children were included; 38 (68%) were male; and 48 (86%) were HIV positive, of whom 36 (77%) were on ART at diagnosis. Median age at diagnosis was 8 years (interquartile range [IQR] 3–12) and median follow-up was 16.9 months (IQR 3.4–36.4). Quality of life improved in 45 (80%) children; the median Lansky Score increased from 80% pre-treatment to 100% post-treatment. Eighteen (32%) children had complete response to treatment. At 12 months, overall survival was 71% (95% confidence interval [CI] 56–82) and event-free survival (event = death, loss to follow-up or relapse) was 50% (95% CI 36–63). At 1 year, the risk of loss to follow-up was 13.4%. In a previous, same-site, randomized controlled study of vincristine monotherapy, vincristine and bleomycin, or oral etoposide, oral etoposide monotherapy had the best outcome with survival at 12 month of 66% (95% CI 46–80) and event-free survival of 52% (95% CI 33–68); however, loss to follow-up was not reported. Conclusion: Overall survival, event-free survival and quality of life appear to have improved with this three-agent combination chemotherapy; however larger, randomized studies are needed to determine optimal management.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85030713081&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/28988435

U2 - 10.1002/pbc.26841

DO - 10.1002/pbc.26841

M3 - Article

VL - 65

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

SN - 1545-5009

IS - 2

M1 - e26841

ER -