• Etoposide (VP-16), given either orally or intravenously, is an attractive drug because it is well tolerated. It is
difficult to use, however, because of its potential to depress blood counts in people who may already have
marginal blood counts. Where it can be used, it has a high response rate. The same general comments apply to
doxorubicin , which can be used only intravenously.
• Daunomycin is very similar to doxorubicin chemically. When coated with fat (lipid) it sppears to concentrate
in and be active in KS lesions. Studies show a 70 percent response rate with low toxicity. The drug is
available in Europe, with Phase III investigational studies being completed in North America.
• Bleomycin is active against KS, although it appears to be more effective in combinations than as a single agent.
Responses to it as a single agent appear to be short, but very little blood count depression occurs.
• Methotrexate is similarly active, and ways can be found to give it with little blood count depression. Its use is
limited, however, because it can cause rather marked blistering of the mouth.
• Among the new agents being tested are drugs related to tretinoin, an anti-wrinkle drug.
Combination Chemotherapy In the early days of AIDS, combinations of chemotherapy drugs were nearly always used. They fell into disfavor because of the high death rate from drug toxicity, often resulting in infections such as pneumocystis pneumonia. With the use of newer drugs such as AZT, inhaled pentamidine and foscarnet and with combination therapy for Mycobacterium avium infections, combinations are being used again, with higher response rates.
