Treatment of AIDS-associated malignancy

Neoplasms associated with acquired immunodeficiency syndrome (AIDS) present unique therapeutic challenges. High-grade systemic lymphomas, although often responsive to standard chemotherapy, will require the addition of CSFs, infection prophylaxis, and antiretroviral drugs to overcome poor marrow reserves, short response durations, and opportunistic infections. Treatment of primary central nervous system (CNS) lymphomas is complicated by their frequent occurrence as a late complication in debilitated patients. AIDS-associated Kaposi's sarcoma (KS) is a unique neoplasm whose pathogenesis is only beginning to be understood. Although responsive to standard therapy (RT, chemotherapy), considerable attention has been focused on the therapeutic potential of BRMs. Interferon alpha (IFN-alpha), which combines antiviral, antiproliferative, and immunoregulatory activities, has significant anti-KS activity, particularly in symptom-free patients with mild immunosuppression. Preliminary data links IFN-induced regression of KS to its anti-HIV activity and supports a role for endogenous IFN-alpha in the induction of refractoriness to IFN treatment. Recent data suggest synergistic anti-HIV and anti-KS activity for the combination of IFN-alpha and AZT. Additional study is needed to evaluate IFN effects on autocrine growth factors regulating the growth of KS.