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Guidelines for Vincristine Management in Kaposi's Sarcoma at Tiyanjane Clinic

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Detailed guidelines for the clinical management of Kaposi's Sarcoma using Vincristine at Tiyanjane Clinic, focusing on criteria, diagnosis, treatment, and symptom control. Includes relevant exclusion and prioritization criteria.

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Guidelines for Vincristine Management in Kaposi's Sarcoma at Tiyanjane Clinic

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  1. MOH KS management guidelines Jane Bates Tiyanjane Clinic, QECH October 2009

  2. Criteria for vincristine Clinical diagnosis of KS Testedfor HIV On ARVs for at least 3 months advanced and / or progressive disease (check FBC) - consider vincristine improving and / or stable disease - hold vincristine • High priorityMedium Priority consider continue ARVS • may start before unilat or biilat. leg if exclusions • 3 months ARVs completed KS limiting function apply •  confirmed or suspected  oral lesions • Pulmonary KS •  rapidly progressivemaintain pain and • disease Involving facesymptom control

  3. Exclusions Absolute • severe peripheral neuropathy • unable to travel – financial or physical constraints • Hb < 8, platelet < 150 • severe liver disturbance/disease Relative • near to another hospital site delivering chemotherapy • minimal disease

  4. 2mg × six doses weekly Six week review If ‘no effect’, side effects and /or limited stable disease - discontinue If ‘good effect’, minimal side effects and residual disease – continue 2mg × six doses fortnightly Review (as for six week review) 2mg × six doses monthly Review at end of schedule + Review 3 months post treatment Initial assessment visit

  5. Pain and symptom control • Assess and treat pain according to WHO analgesic ladder • Salicylic acid cream/antihistamines for itching • Crushed metronidazole to reduce smell • potassium permanganate soaks to dry excess oozing • Wound care, nutrition assessment and advice

  6. WHO 3-stepLadder 3 severe Morphine ± step 1 and/or Adjuvants 2 moderate A/Codeine A/Dihydrocodeine Tramadol ± step 1 and/or Adjuvants 1 mild Aspirin Paracetemol NSAIDs ± Adjuvants

  7. Other issues to consider • This treatment regime is not curative • Patients/guardians need counselling about nature of disease to assist with having realistic expectations • A major part of management is managing expectations of patients, so information needs to be clear, consistent and honest • At Tiyanjane we use a Chichewa information sheet for literate patients (double side A4) which you can have a copy of. If its of use photocopy and give out. • If vincristine is not helping don’t continue it, aim for patient comfort and quality of life

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