Challenges and Opportunities for Kaposi Sarcoma Clinical Trials in Sub-Saharan Africa: A Review

Kaposi sarcoma is a vascular tumor that remains a significant global public health challenge, with approximately 70% of cases occurring in sub-Saharan Africa (SSA) where Human Immunodeficiency Virus (HIV) and Human Herpesvirus 8 (HHV-8) are highly prevalent. Furthermore, relatively few clinical trials have been conducted in SSA, potentially delaying the development of more effective interventions for this cancer. This review evaluated completed prospective clinical trials for the treatment of HIV-associated Kaposi sarcoma (KS) conducted in sub-Saharan Africa (SSA) and highlighted the complementary role of investigator-initiated clinical trials in drug development. We searched the internet and medical databases using relevant key terms. We identified 171 indexed HIV-KS clinical trials worldwide and extracted seven that were conducted in SSA between 1984 and July 2022. The first trial took place in Zimbabwe and was published in 2005. The second and third trials were conducted in South Africa and published in 2008 and 2012, respectively. The fourth and sixth trials were done in Kenya, Uganda, South Africa, Zimbabwe, and Brazil and were published in 2018 and 2020. The fifth was an investigator-initiated trial (IIT) done in Kenya and published between 2018 and 2019. The sixth trial featured the largest sample size and the most diverse study population. The seventh evaluated the effectiveness of locally sourced compression bandages for HIV-KS leg lymphedema in Kenya and was published in 2022. The number of clinical trials for interventions to treat HIV-KS in SSA remains disproportionate to the high burden of the disease in the region. Highlighting these research gaps may stimulate interest in studies aimed at finding a cure for HIV-KS in sub-Saharan Africa.