Phase II Open Label Pilot Trial of Empiric Daptomycin Treatment for Oncology Patients With Neutropenic Fever
- Assess the response rate to therapy within 72 hours of starting daptomycin in cancer
patients with neutropenic fever.
- Assess the percentage of bacterial cures in patients with documented gram-positive
- 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.
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Supportive Care
Number of Participants Who Became Afebrile Within 72 Hours of Starting Daptomycin.
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.
Within 72 hours of starting daptomycin
Joseph Bubalo, PharmD
OHSU Knight Cancer Institute
United States: Food and Drug Administration
|OHSU Knight Cancer Institute||Portland, Oregon 97239|