Endemic Kaposi’s Sarcoma

SIMPLE SUMMARY: Endemic Kaposi’s sarcoma (KS) remains a major public health concern in Eastern and Central Africa, and diagnostic and therapeutic management represents a great challenge in a setting of financial limitations in resource-poor environment. Factors arising from specific ethnic behavior and geographical variation are responsible for the development of KS in the African population infected with HHV-8 mostly through salivary transmission. Our review provides an overview of the clinical characteristics and discusses the therapeutic challenges of this subtype. As endemic KS may follow an aggressive course, it often requires the use of systemic therapy. Immune checkpoint blockade could represent a promising alternative for chemotherapy-refractory endemic KS. ABSTRACT: Kaposi’s sarcoma (KS) is a common neoplasm in Eastern and central Africa reflecting the spread of human gammaherpesvirus-8 (HHV-8), now considered a necessary causal agent for the development of KS. The endemic KS subtype can follow an aggressive clinical course with ulcerative skin lesions with soft tissue invasion or even bone or visceral involvement. In the latter cases, a thorough imaging work-up and better follow-up schedules are warranted. As KS is a chronic disease, the therapeutic goal is to obtain sustainable remission in cutaneous and visceral lesions and a good quality of life. Watchful monitoring may be sufficient in localized cutaneous forms. Potential therapeutic modalities for symptomatic advanced KS include systemic chemotherapies, immunomodulators, immune checkpoint inhibitors, and antiangiogenic drugs.