On May 14, 2020, the U.S. Food and Drug Administration (FDA) expanded the indication of pomalidomide (Pomalyst) to include treating adult patients with acquired immunodeficiency syndrome (AIDS)-related Kaposi sarcoma after failure of highly active antiretroviral therapy and those with Kaposi sarcoma who are human immunodeficiency virus (HIV)-negative.
Efficacy was investigated in Study 12-C-0047, an open-label, single-arm clinical trial conducted by the National Cancer Institute. Twenty-eight patients (18 HIV-positive, 10 HIV-negative) received 5 mg of pomalidomide orally once daily on days 1 through 21 of each 28-day cycle until disease progression or unacceptable toxicity. All HIV-positive patients continued highly active antiretroviral therapy.
The main efficacy outcome measure was overall response rate, which included complete response, clinical complete response, and partial response. Response was assessed by the investigator according to the AIDS Clinical Trial Group Oncology Committee response criteria for Kaposi sarcoma.
Among the 18 HIV-positive patients, the overall response rate was 67% (95% CI = 41%–87%) with a median response duration of 12.5 months (95% CI = 6.5–24.9). Among the 10 HIV-negative patients, the overall response rate was 80% (95% CI = 44%–98%) with a median response duration of 10.5 months (95% CI = 3.9–24.2).
The most common adverse reactions including laboratory abnormalities (≥ 30% of patients) among those who received pomalidomide were decreased absolute neutrophil count or white blood cells, elevated creatinine or glucose, rash, constipation, fatigue, decreased hemoglobin, platelets, phosphate, albumin, or calcium, increased ALT, nausea, and diarrhea.
The recommended pomalidomide dose for Kaposi sarcoma is 5 mg once daily taken orally with or without food on days 1 through 21 of each 28‑day cycle until disease progression or unacceptable toxicity. Prescribing information indicates that highly active antiretroviral therapy as HIV treatment in should be continued for patients with AIDS-related Kaposi sarcoma.