Liposomal Doxorubicin and Interleukin-12 in Treating Patients With AIDS-Related Kaposi's Sarcoma

DISEASE CHARACTERISTICS:

• Histologically confirmed Kaposi's sarcoma (KS)
• HIV positive

• Evaluable disease involving the skin and/or viscera

  • At least 5 lesions not previously treated with local therapy if restricted to the skin
  • Pulmonary lesions evaluable by CT scan
  • Gastrointestinal lesions evaluable by visualization or fiberoptic instrumentation

• Presence of at least one of the following indications for cytotoxic chemotherapy:

  • Pulmonary involvement
  • Visceral involvement
  • Pain
  • Edema
  • Ulcerating lesions
  • Decreased range of joint motion due to KS
  • Multiple lesions not amenable to local therapy
  • Lymphedema that impairs mobility or range of motion
  • Significant psychological impact leading to social withdrawal
• Progressive disease within the past 3 weeks while receiving a stable regimen of highly active antiretroviral therapy for at least 4 weeks unless there is a need for urgent chemotherapy

• Prior participation on this study allowed, provided patient was removed from study due to non-pancreatic hyperamylasemia and the following are true:

  • No dose-limiting toxicity by clinical and laboratory assessment
  • Pancreatic amylase portion normal by fractionated amylase
  • Lipase normal
  • No symptoms referable to the pancreas

PATIENT CHARACTERISTICS:

Age:

• 18 and over

Performance status:

• Karnofsky 30-100%

Life expectancy:

• More than 2 months

Hematopoietic:

• Hemoglobin at least 9.0 g/dL
• Absolute neutrophil count at least 750/mm^3
• Platelet count at least 75,000/mm^3

Hepatic:

• Bilirubin no greater than 3.8 mg/dL with direct fraction no greater than 0.3 mg/dL and indirect fraction no greater than 3.5 mg/dL if due to protease inhibitor therapy
• PT or aPTT no greater than 120% of control unless due to lupus-type anticoagulant
• AST no greater than 2.5 times upper limit of normal
• No prior hepatic cirrhosis
• No hepatic dysfunction

Renal:

• Creatinine no greater than 1.5 mg/dL
• Creatinine clearance at least 60 mL/min

Cardiovascular:

• No congestive heart failure
• Ejection fraction at least 40% by MUGA or echocardiogram

Other:

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective barrier contraception during and for 2 months after study participation
• No clinically significant autoimmune disease
• No active, gross gastrointestinal bleeding or uncontrolled peptic ulcer disease
• No prior inflammatory bowel disease
• No other prior or concurrent malignancy except squamous cell carcinoma in situ of the cervix or anus, completely resected basal cell carcinoma, or malignancy in complete remission for at least 1 year from the time a response was first documented
• No severe or life-threatening infection within the past 2 weeks
• No abnormality that would be scored as grade 3 toxicity except lymphopenia or direct manifestations of KS
• No known hypersensitivity to interleukin-12 (IL-12) or other compounds known to cross-react with IL-12
• No other medical condition that would preclude study entry

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• More than 2 weeks since prior cytokines or colony-stimulating factors other than epoetin alfa, filgrastim (G-CSF), or sargramostim (GM-CSF)
• No prior combination interleukin-12 and doxorubicin HCl liposome except for patients previously treated on this protocol who are being enrolled for paclitaxel salvage therapy
• No concurrent immunomodulatory agents
• No concurrent cytokines except epoetin alfa or G-CSF

Chemotherapy:

• See Disease Characteristics
• See Biologic therapy
• At least 3 weeks since prior chemotherapy (6 weeks for mitomycin or nitrosoureas)
• More 6 months since prior suramin
• No other concurrent cytotoxic chemotherapy

Endocrine therapy:

• More than 2 months since prior systemic glucocorticoid steroids at doses sufficient to affect immune response (e.g., more than 20 mg of prednisone for more than 1 week)
• Concurrent replacement glucocorticoid therapy allowed
• No other concurrent systemic glucocorticoid therapy

Radiotherapy:

• Not specified

Surgery:

• Not specified

Other:

• Concurrent antiretroviral therapy required
• No other concurrent anti-KS therapy