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Treatment plan — Kaposi sarcoma

PLAN-VERIFIED-KAPOSI-L1-KAPOSI_1L_VISCERAL_PLD-V1 · v1 · 2026-07-15

Patient

VERIFIED-KAPOSI-L1-KAPOSI_1L_VISCERAL_PLD · Algorithm: ALGO-KAPOSI-1L

DiagnosisKaposi sarcoma

MOH / ICD-10C46

ICD-O-39140/3; C46

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.

Primary current-line option

Standard plan

★ DEFAULT

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

Primary current-line option selected by ALGO-KAPOSI-1L at step 1; branch-driving red flag: RF-KAPOSI-VISCERAL-EXTENSIVE-DISEASE.

Other current-line alternatives (3 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.

Standard plan

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

Current-line alternative presented for HCP consideration

Standard plan

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

Local therapy plan

Indication: IND-KAPOSI-1L-CLASSIC-LOCAL-OBSERVATION
Regimen: —
Reason: Current-line alternative presented for HCP consideration

Why this branch was chosen

Triggers from the patient profile that fired and drove the chosen branch.

Step 1 → branch IND-KAPOSI-1L-VISCERAL-PLD

RF-KAPOSI-VISCERAL-EXTENSIVE-DISEASE ★ winner: Visceral organ involvement (pulmonary, gastrointestinal, or other visceral site) OR extensive/rapidly progressive mucocutaneous disease (widespread cutaneous lesions, tumor-associated lymphedema, or ulceration) in Kaposi sarcoma of any epidemiologic form (AIDS- associated, iatrogenic, classic, or endemic). Symptomatic/extensive disease of this kind is not expected to be adequately controlled by immune restoration (ART / immunosuppression rebalance) or local therapy alone and drives escalation to systemic chemotherapy. SRC-NCCN-SKIN-2025SRC-NIH-AIDS-2024

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	—	standard
TEST-CT-CHEST-ABDOMEN-PELVIS	CT chest + abdomen + pelvis with IV contrast	Critical	imaging	—	standard
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	—	standard
TEST-ECHO	Echocardiography	Standard	imaging	—	standard

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Visceral organ involvement (pulmonary, gastrointestinal, or other visceral site) OR extensive/rapidly progressive mucocutaneous disease (widespread cutaneous lesions, tumor-associated lymphedema, or ulceration) in Kaposi sarcoma of any epidemiologic form (AIDS- associated, iatrogenic, classic, or endemic). Symptomatic/extensive disease of this kind is not expected to be adequately controlled by immune restoration (ART / immunosuppression rebalance) or local therapy alone and drives escalation to systemic chemotherapy.
New disease-extent gate authored for the DIS-KAPOSI treatment pathway (v0.3 continuation -- closes the "missing TREATMENT-intent Indications" gap). Distinct from the pre-existing PREVENTION-persona RF-CHRONIC-HHV8-MALIGNANCY-PREVENTION…
RF-KAPOSI-VISCERAL-EXTENSIVE-DISEASESRC-NCCN-SKIN-2025SRC-NIH-AIDS-2024

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-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.

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.

Local therapy plan (IND-KAPOSI-1L-CLASSIC-LOCAL-OBSERVATION)

Do not skip histologic confirmation and exclusion of HIV-associated / iatrogenic forms before choosing an observation strategy.
Do not use systemic chemotherapy as first-line therapy for limited cutaneous classic/endemic disease.
Do not ignore signs of progression -- reassess against IND-KAPOSI-1L-VISCERAL-PLD.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Pegylated liposomal doxorubicin monotherapy (Kaposi sarcoma)

21-day cycles × Until progression or unacceptable toxicity (typically reassess response after 3-6 cycles)

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

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)

Social worker / case manager recommended
Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

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	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	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)

Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-07-15.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT04968288	Natural History of KSHV-Associated Multicentric Castleman s Disease	N/A	RECRUITING	National Cancer Institute (NCI)	—	Single country
NCT03889899	Alpha Radiation Emitters Device (DaRT) for the Treatment of Cutaneous, Mucosal or Superficial Soft Tissue Neoplasia.	NA	RECRUITING	Alpha Tau Medical LTD.	—	Small N (<50) Single country
NCT03300830	Molecular Characterization of Viral-associated Tumors, Tumors Occurring in the Setting of HIV or Other Immune Disorders and Castleman Disease	N/A	RECRUITING	National Cancer Institute (NCI)	—	Single country
NCT07066982	Sequential Infusion of CD146-Targeted and HER2-Targeted CAR T Cells in Patients With Advanced Sarcomas	PHASE1 / PHASE2	RECRUITING	Essen Biotech	—	Single country
NCT06004011	AYAHIV Role-based Responsibilities for Oncology-focused Workforce (ARROW)	NA	RECRUITING	Implenomics	—	Single country
NCT04534127	Alpha Radiation Emitters Device (DaRT) for the Treatment of Cutaneous, Mucosal or Superficial Soft Tissue Neoplasia	NA	RECRUITING	Alpha Tau Medical LTD.	—	Single country
NCT04303117	PDS01ADC Monotherapy and in Combination With M7824 in Advanced Kaposi Sarcoma	PHASE1 / PHASE2	RECRUITING	National Cancer Institute (NCI)	—	Single country
NCT00006518	Specimen Collections From Participants With HIV Infection, KSHV Infection, Viral-Related Pre-malignant Lesions and Cancer	N/A	RECRUITING	National Cancer Institute (NCI)	—	Single country
NCT06236022	The Effects of Sirolimus in Patients With Dilated Cardiomyopathy Infected With Kaposi Sarcoma-associated Virus	PHASE4	RECRUITING	Tongji Hospital	—	Single country
NCT05859074	A Study of MQ710 With and Without Pembrolizumab in People With Solid Tumor Cancer	PHASE1	RECRUITING	Memorial Sloan Kettering Cancer Center	—	Phase 1 only Single country

Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.

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 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
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
Local therapy plan — No regimen components on this track — availability unknown	— unknown	— unknown	₴-? — verify pathway	not recorded
Trial · NCT04968288 Natural History of KSHV-Associated Multicentric Castleman s Disease No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03889899 Alpha Radiation Emitters Device (DaRT) for the Treatment of Cutaneous, Mucosal or Superficial Soft Tissue Neoplasia. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03300830 Molecular Characterization of Viral-associated Tumors, Tumors Occurring in the Setting of HIV or Other Immune Disorders and Castleman Disease No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07066982 Sequential Infusion of CD146-Targeted and HER2-Targeted CAR T Cells in Patients With Advanced Sarcomas No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06004011 AYAHIV Role-based Responsibilities for Oncology-focused Workforce (ARROW) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04534127 Alpha Radiation Emitters Device (DaRT) for the Treatment of Cutaneous, Mucosal or Superficial Soft Tissue Neoplasia No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04303117 PDS01ADC Monotherapy and in Combination With M7824 in Advanced Kaposi Sarcoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT00006518 Specimen Collections From Participants With HIV Infection, KSHV Infection, Viral-Related Pre-malignant Lesions and Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06236022 The Effects of Sirolimus in Patients With Dilated Cardiomyopathy Infected With Kaposi Sarcoma-associated Virus No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05859074 A Study of MQ710 With and Without Pembrolizumab in People With Solid Tumor Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-07-15.

plan_id: PLAN-VERIFIED-KAPOSI-L1-KAPOSI_1L_VISCERAL_PLD-V1 | version: 1 | generated: 2026-07-15T13:33:22.896212+00:00

Per FDA non-device CDS positioning (CHARTER §15): Outpatient oncology treatment planning to support tumor-board discussion. Not a medical device; not for autonomous clinical decision-making.

Per FDA non-device CDS positioning (CHARTER §15): Both treatment options below are presented for review. The engine's selection of a 'recommended' default does not constitute a clinical decision. Final treatment selection requires HCP judgment incorporating information not available to the system.

This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.