How do you approach a well controlled HIV patient with diffuse cutaneous kaposi sarcoma who failed to respond to radiation, paclitaxel and monthly liposomal doxorubicin?

Please consider using Pomalidomide 5 mg PO daily (21 days on and seven days off in a 28-day cycle). (Polizotto et al., PMID 27863194). There is significant activity in HIV-positive patients of this regimen (ORR-60%). The NCCN also endorses Pomalyst as a treatment for KS.

Other than this, checkpoint inhibitor therapy can also be used in the treatment of refractory KS. However, I do not recommend checkpoint inhibition before trying pomalidomide. This is still not endorsed by NCCN, but a phase 2 tr...