What is chemotherapy?

Chemotherapy (chemo) uses strong medicines to kill cancer cells. They attack and kill cells that grow quickly, such as cancer cells. Some normal cells also grow quickly. Because of this, chemo can harm those cells. This can cause side effects.

How is chemotherapy given for Kaposi sarcoma?

Before treatment starts for Kaposi sarcoma (KS), you will meet with a medical oncologist. This is a healthcare provider who specializes in treating cancer with medicines such as chemotherapy. The provider will discuss your treatment options with you and explain what you might expect.

Depending on which chemo medicines you're getting, chemo can be given in different ways:

• IV (intravenous). The chemo is given through a small catheter that's been put into a vein. The medicine goes right into your blood. It may drip in slowly over several hours, or it may be given more quickly over a few minutes. When given this way, the chemo enters the blood and can reach cancer cells all over the body.

• Intralesional. A small needle is used to put the chemo right into the KS lesions. The advantage of getting chemo this way is that most of it stays in the area where it was injected. This limits the side effects it causes. But chemo given this way can treat only the lesions it's injected into. It can’t reach cancer cells in other parts of the body.

Chemo is usually given in an outpatient setting. That means that you get it at a hospital, clinic, or healthcare provider's office. You can go home after the treatment. Less often, you may need to stay in the hospital during treatment. Nurses will give the chemo and watch you closely for problems or reactions during treatments. Each chemo treatment may last for a while. You may want to take along something to do, like read a book, listen to music, or watch videos.

To reduce the damage to healthy cells and give them a chance to recover, chemo is often given in cycles. Each cycle consists of one or more days of treatment, followed by some time to rest and recover. You may get several cycles. Your healthcare provider will discuss your chemo schedule with you.

When might chemotherapy be used for Kaposi sarcoma? 

These are the main ways chemo can be useful in treating KS:

• Intralesional chemotherapy might be used to treat KS lesions that have affected how you look, or that are causing symptoms like swelling or pain. Intralesional chemo can often shrink these lesions. But it doesn't stop new lesions from forming in other parts of your body.

• IV chemo is often used as part of the treatment for more advanced KS, or KS that is progressing quickly. For AIDS-related KS, chemo is given along with HAART (highly active antiretroviral therapy) to treat the HIV infection.

What chemo medicines are used to treat Kaposi sarcoma?

If IV chemo is needed to treat KS, medicines called liposomal anthracyclines are usually the first ones used. These are chemo medicines inside tiny fat bubbles called liposomes. The fat bubbles help the medicine get into the cancer cells and cause fewer side effects. The liposomal anthracyclines used to treat KS are liposomal doxorubicin and liposomal daunorubicin.

These medicines often produce good and long-lasting responses by shrinking tumors and reducing swelling.

Other chemo medicines used to treat KS include:

• Bleomycin

• Etoposide

• Gemcitabine

• Paclitaxel

• Nab-paclitaxel

• Vinblastine

• Vincristine

• Vinorelbine

Vinblastine is the most common medicine used for intralesional chemotherapy.

What are common side effects of chemotherapy?

Side effects of chemo are different for everyone. They depend on which medicines are used and the dose. Most can be treated, and nearly all go away after treatment is over.

Side effects are much more common for IV chemo than for intralesional chemo. Ask your healthcare provider what side effects to watch for. Tell them about any side effects right away.

These are some of the most common side effects of chemo:

• Hair loss

• Nausea and vomiting

• Mouth sores

• Diarrhea

• Loss of appetite and/or changes in the way things taste

Another common side effect is a decrease in blood counts, which can cause problems like:

• Decrease in white blood cells. This puts you at a higher risk for infections. If you have a fever during chemo, tell your healthcare provider or nurse right away.

• Decrease in platelets. This puts you at risk for bleeding. Tell your healthcare provider or nurse about any bleeding or easy bruising you have during chemo.

• Decrease in red blood cells. This causes fatigue, weakness, and a lack of energy. These symptoms can be treated. Tell your healthcare provider or nurse about them.

Some other side effects are linked to certain chemo medicines. For instance, vincristine, paclitaxel, and some other medicines can cause nerve damage (peripheral neuropathy). This can lead to pain, tingling, and numbness in your hands and feet.

Many chemo side effects can be treated to keep them from getting worse. There may even be things you can do to help prevent some of them. Most side effects go away over time after treatment ends.

Working with your healthcare provider

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what symptoms to watch for and when to call them. For instance, chemo can make you more likely to get infections. You may be told to check your temperature and stay away from people who are sick. You may need to call if you have a fever or chills. Make sure you know what number to call with problems or questions. Is there a different number for evenings, holidays, and weekends?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.