Classic Kaposi sarcoma (CKS) represents an angioproliferative disease that is originated from endothelial cells, myofibroblasts, and monocyte-macrophage cells. It occurs predominantly in elderly people, particularly men from the Mediterranean area. CKS is described as a disease with a long indolent course but frequently shows a rapid progressive evolution that necessitates systemic chemotherapy. Considering that afflicted patients are often >75 years old, the need to use a convenient treatment schedule with few side effects is evident. No standard therapy is used for CKS and treatment must be tailored to the individual patient. This report summarizes all treatment options in CKS, including classical systemic chemoterapy, immunotherapy, and radiotherapy. Among chemotherapeutic agents, recent data are offered from current trials that have focused on the role of pegylated liposomal doxorubicin as first- and second-line therapy.