Daptomycin in Treating Neutropenia and Fever in Patients With Cancer
- Full Text View
- Tabular View
- Study Results
- Disclaimer
- How to Read a Study Record
Purpose
RATIONALE: Antibiotics, such as daptomycin, may control neutropenia, fever, and infection in patients with cancer.
PURPOSE: This phase II trial is studying how well daptomycin works in treating neutropenia and fever in patients with cancer.
| Condition | Intervention | Phase |
|---|---|---|
|
Fever Sweating Hot Flashes Infection Neutropenia Unspecified Adult Solid Tumor, Protocol Specific |
Drug: Daptomycin |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Supportive Care |
| Official Title: | Phase II Open Label Pilot Trial of Empiric Daptomycin Treatment for Oncology Patients With Neutropenic Fever |
- Number of Participants Who Became Afebrile Within 72 Hours of Starting Daptomycin. [ Time Frame: Within 72 hours of starting daptomycin ] [ Designated as safety issue: No ]
If after 72 hours of daptomycin treatment, the patient is afebrile and has absolute neutrophil count (ANC) >500 cells/mm^3 for 48 hours with no site of infection, negative cultures, and no clinical indications for therapy, the antibiotic regimen will be discontinued.
Complete Response: Resolution of fever and clinical signs/symptoms of infection.
Partial Response: Resolution of fever without resolution of clinical signs of infection.
| Enrollment: | 54 |
| Study Start Date: | December 2006 |
| Study Completion Date: | October 2008 |
| Primary Completion Date: | October 2008 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| Experimental: Daptomycin |
Drug: Daptomycin
daptomycin 6 mg/kg over 30 minutes every 24 hours until patient is afebrile and ANC is >500 cells/mm^3.
Other Name: Cubicin
|
Detailed Description:
OBJECTIVES:
Primary
- Assess the response rate to therapy within 72 hours of starting daptomycin in cancer patients with neutropenic fever.
Secondary
- Assess the percentage of bacterial cures in patients with documented gram-positive bacterial infections.
- Assess time to afebrile state.
- Assess the pharmacokinetic data of daptomycin in neutropenic patients.
- Document the incidence of breakthrough infections that require a change of therapy or additional agents to clear.
- Assess the tolerability of daptomycin in neutropenic patients.
- Assess and document adverse events and toxicity due to daptomycin.
OUTLINE: This is an open-label, pilot study.
Patients first receive standard treatment for gram-negative bacteria for 72 hours. If the patient is still febrile at 72 hours, daptomycin is administered.
Patients receive daptomycin IV over 30 minutes once daily. Patients who are afebrile, not neutropenic (absolute neutrophil count [ANC] > 500/mm³), and have no signs of infection after 72 hours of therapy may discontinue daptomycin. Patients who are afebrile and neutropenic (ANC < 500/mm³) after 72 hours of therapy continue to receive daptomycin until absolute neutrophil count (ANC) > 500/mm³ for 2 consecutive days. Patients who are febrile with or without continued neutropenia (ANC < 500/mm³) after 72 hours of therapy continue to receive daptomycin for up to 10-14 days in the absence of unacceptable toxicity.
PROJECTED ACCRUAL: A total of 30 patients will be accrued for this study.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
- Diagnosis of cancer
Diagnosis of neutropenic fever
- Temperature > 38.3°C once OR ≥ 38°C twice within 12 hours
Absolute neutrophil count < 500/mm^³ and ≥ 1 of the following:
- Mucositis
- Concurrent skin or soft tissue infection
- Indwelling catheter and/or suspected catheter infection
- Recent quinolone prophylaxis
- Positive blood cultures for gram-positive cocci before final identification or other documented gram-positive pathogen
- Colonization with β-lactam resistant gram-positive organisms (commonly the nares or the skin)
- Hypotension, tachycardia, narrowed pulse pressures, tachypnea, or other signs of cardiovascular compromise
- Expected duration of neutropenia ≥ 3 days
- No known infection with daptomycin-resistant organism or gram-negative organism and not yet meeting criteria for the addition of gram-positive antimicrobial therapy
- No suspected meningitis or osteomyelitis
- No documented or suspected gram-positive pneumonia
- No suspected or proven endocarditis
PATIENT CHARACTERISTICS:
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2
- Life expectancy ≥ 2 weeks
- Creatinine clearance ≥ 50 mL/min
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective double-method contraception
- No known sensitivity to daptomycin or product excipients
- No history of or concurrent rhabdomyolysis
- No HIV positivity
- No psychiatric disorders that would preclude study compliance
No signs or symptoms of myopathy with creatine phosphokinase (CPK) elevation > 1,000 U/L (5 times upper limit of normal [ULN])
- No CPK elevations > 10 times ULN in patients with no signs or symptoms of myopathy
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- At least 7 days since prior daptomycin or other antibiotic agents covering gram-positive organisms
- No concurrent hemodialysis or continuous ambulatory peritoneal dialysis
- No concurrent succinylcholine, ethanol, fludrocortisone, olanzapine, or pioglitazone
- No concurrent hydroxymethyl glutaryl (HMG) coenzyme A (HMG CoA) reductase inhibitors (e.g., lovastatin, simvastatin, atorvastatin)
- Concurrent therapy for gram-negative bacterial infection allowed
Contacts and Locations| United States, Oregon | |
| OHSU Knight Cancer Institute | |
| Portland, Oregon, United States, 97239 | |
| Principal Investigator: | Joseph Bubalo, PharmD | OHSU Knight Cancer Institute |
More Information
Additional Information:
No publications provided
| Responsible Party: | OHSU Knight Cancer Institute |
| ClinicalTrials.gov Identifier: | NCT00335478 History of Changes |
| Other Study ID Numbers: | CDR0000476568, OHSU-CPC-05052-L, OHSU-1321, CUBIST-OHSU-CPC-05052-L |
| Study First Received: | June 8, 2006 |
| Results First Received: | June 7, 2011 |
| Last Updated: | May 24, 2012 |
| Health Authority: | United States: Food and Drug Administration |
Keywords provided by OHSU Knight Cancer Institute:
|
neutropenia infection unspecified adult solid tumor, protocol specific fever, sweats, and hot flashes |
Additional relevant MeSH terms:
|
Fever Neutropenia Hot Flashes Body Temperature Changes Signs and Symptoms Agranulocytosis Leukopenia |
Leukocyte Disorders Hematologic Diseases Daptomycin Anti-Bacterial Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions |
ClinicalTrials.gov processed this record on May 19, 2013