Patient
VERIFIED-KAPOSI-L1-KAPOSI_1L_AIDS_ART · Algorithm: ALGO-KAPOSI-1L
Etiological driver
Etiological driver · etiologically_driven archetype
Kaposi sarcoma
- HHV-8 / KSHV (Kaposi sarcoma-associated herpesvirus) — IARC Group 1 carcinogen; obligate etiology
- HIV-related immunocompromise (AIDS-defining malignancy)
- Iatrogenic immunosuppression (solid-organ transplant recipients; post-transplant tumor regression with mTOR-inhibitor conversion is documented)
- Classic (Mediterranean / elderly male) form — HHV-8 prevalent regions
- Endemic (sub-Saharan African) form — HHV-8 prevalent without HIV
Clinical significance of mutations (ESCAT)
Tumor-board context — the engine does not use these tiers to rank tracks
| Biomarker | Variant | ESCAT | Evidence | Clinical significance | Drugs | Sources |
|---|
| No clinically actionable variants matched in this profile. |
| Biomarker | Status |
|---|
| BIO-HIV-STATUS | BIO definition in KB; no ESCAT BMA entry — verify with clinician |
Primary current-line option
- Indication
- IND-KAPOSI-1L-AIDS-ART
- Regimen
- Biktarvy — bictegravir/emtricitabine/tenofovir-AF single-tablet ART
- Drugs + NSZU
- Bictegravir / Emtricitabine / Tenofovir alafenamide (DRUG-BICTEGRAVIR-EMTRICITABINE-TENOFOVIR-AF) 50/200/25 mg PO (single tablet) · once daily, with or without food · PO ⚠ NSZU — not for this indication
- Reason
- Primary current-line option per algorithm ALGO-KAPOSI-1L: selected default was filtered; promoted first remaining current-line track
Other current-line alternatives (2 tracks)
Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
- Indication
- IND-KAPOSI-1L-IATROGENIC-MTOR-CONVERSION
- Regimen
- Sirolimus conversion (iatrogenic/transplant-associated Kaposi sarcoma)
- Drugs + NSZU
- Sirolimus (DRUG-SIROLIMUS) Per transplant-team protocol -- typically initiated at low dose (e.g. 1-2 mg PO once daily) and titrated to institutional/transplant-program target trough level while the calcineurin-inhibitor component of the immunosuppression regimen is tapered · Continuous; conversion performed under transplant-team supervision with graft-function monitoring · PO ⚠ Out-of-pocket
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-KAPOSI-1L-VISCERAL-PLD
- Regimen
- Pegylated liposomal doxorubicin monotherapy (Kaposi sarcoma)
- Drugs + NSZU
- Pegylated liposomal doxorubicin (DRUG-PEGYLATED-LIPOSOMAL-DOXORUBICIN) 20 mg/m² IV every 2-3 weeks · Day 1 of each 14-21 day cycle · IV ⚠ Out-of-pocket
- Reason
- Current-line alternative presented for HCP consideration
Pre-treatment investigations
Investigations before treatment start · critical / standard / desired · merged across tracks
| ID | Name | Priority | Category | Where to order | Needed for |
|---|
| TEST-BRONCHOSCOPY-WITH-EBUS | Bronchoscopy with EBUS | Critical | histology | — | desired (standard) |
| TEST-CBC | Complete Blood Count with Differential | Critical | lab | — | all tracks |
| TEST-CMP | Comprehensive Metabolic Panel | Critical | lab | — | all tracks |
| TEST-CT-CHEST-ABDOMEN-PELVIS | CT chest + abdomen + pelvis with IV contrast | Critical | imaging | — | all tracks |
| TEST-EXCISIONAL-SKIN-BIOPSY | Excisional skin biopsy | Critical | histology | — | all tracks |
| TEST-HIV-SEROLOGY | HIV Antibody/Antigen | Critical | lab | — | all tracks |
| TEST-LFT | Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin) | Critical | lab | — | all tracks |
| TEST-ECHO | Echocardiography | Standard | imaging | — | all tracks |
Red flags — PRO / CONTRA aggressive
PRO-AGGRESSIVE
Triggers that push toward the aggressive track
CONTRA-AGGRESSIVE
Hard contraindications to escalation
What NOT to do
Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Standard plan (IND-KAPOSI-1L-AIDS-ART)
- Do not use ART as sole therapy for visceral or extensive disease -- added systemic chemotherapy is required.
- Do not interrupt ART during any subsequent cancer treatment without an HIV-specialist consult.
- Do not skip drug-drug interaction screening before adding any cancer treatment.
Standard plan (IND-KAPOSI-1L-IATROGENIC-MTOR-CONVERSION)
- Do not change a transplant recipient's immunosuppression regimen unilaterally, without transplant-team consult.
- Do not use mTOR-inhibitor conversion as sole therapy for visceral or extensive disease.
- Do not discontinue immunosuppression entirely -- the goal is rebalancing, not withdrawal.
Standard plan (IND-KAPOSI-1L-VISCERAL-PLD)
- Do not interrupt ART during PLD chemotherapy for the AIDS-associated form.
- Do not change a transplant recipient's immunosuppression without transplant-team consult, even during chemotherapy.
- Do not skip baseline and serial LVEF assessment -- cumulative anthracycline cardiotoxicity risk.
- Do not dilute PLD in normal saline -- disrupts the liposomes; D5W only.
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Standard plan
Induction · Biktarvy — bictegravir/emtricitabine/tenofovir-AF single-tablet ART
30-day cycles × ongoing — long-term suppression
Standard plan
Induction · Sirolimus conversion (iatrogenic/transplant-associated Kaposi sarcoma)
28-day cycles × Long-term continuous
Standard plan
Induction · Pegylated liposomal doxorubicin monotherapy (Kaposi sarcoma)
21-day cycles × Until progression or unacceptable toxicity (typically reassess response after 3-6 cycles)
MDT brief
MDT talk tree (1 steps)
| # | Owner | Topic | Action |
|---|
| 1 | social_worker_case_manager | Specialist review | Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed. |
Skills (recommended) — for consideration (1)
Data quality
Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.
- Biomarker coverage: 1/1 known (100%), 0 missing, 0 default-track gaps
- Unevaluated RedFlags: RF-CHRONIC-HHV8-MALIGNANCY-PREVENTION, RF-IATROGENIC-CALCINEURIN-INHIBITOR-LONGTERM-PREVENTION, RF-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-LONGTERM-PREVENTION, RF-KAPOSI-VISCERAL-EXTENSIVE-DISEASE
Technical MDT skill metadata (1/16 activated in this plan)
All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).
| Specialist | skill_id | Version | Last reviewed | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
Sources cited
- SRC-IARC-MONO-100B-2012: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 100B: A Review of Human Carcinogens. Part B: Biological Agents (Volume 100B (2012))
- SRC-NCCN-SKIN-2025: NCCN Clinical Practice Guidelines in Oncology: Basal Cell Skin Cancer (Version 2.2025) ()
- SRC-NIH-AIDS-2024: NIH HHS Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV; Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV (2024)
Experimental options (clinical trials)
Last synced: 2026-07-15 · ctgov.
No active trials matched this scenario in ctgov.
Option availability in Ukraine
Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).
| Option | UA registration | NSZU | Cost orientation | Access pathway |
|---|
| Standard plan Biktarvy — bictegravir/emtricitabine/tenofovir-AF single-tablet ART (REG-HIV-BIKTARVY) | ✓ registered | ✓ covered | ₴-? — verify pathway | AP-ART-NSZU-HIV |
| Standard plan Sirolimus conversion (iatrogenic/transplant-associated Kaposi sarcoma) (REG-SIROLIMUS-KAPOSI-CONVERSION) 1/1 component drug(s) not on NSZU formulary | ✓ registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Standard plan Pegylated liposomal doxorubicin monotherapy (Kaposi sarcoma) (REG-PLD-KAPOSI) 1/1 component drug(s) not on NSZU formulary | ✓ registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-07-15.