Infection, Unspecified Adult Solid Tumor, Protocol Specific
Conditions
Keywords
infection, unspecified adult solid tumor, protocol specific
Brief summary
RATIONALE: Antifungals such as voriconazole may be effective in controlling fungal infections. Combining voriconazole with interferon gamma may be more effective than voriconazole alone in treating fungal infections. PURPOSE: Randomized phase II trial to compare the effectiveness of voriconazole with or without interferon gamma in treating patients who have aspergillosis or other fungal infections.
Detailed description
OBJECTIVES: * Determine the safety profile of voriconazole and interferon gamma in patients with invasive aspergillosis or other filamentous fungal infections. * Compare the efficacy and possible heterogeneity in efficacy of voriconazole with or without interferon gamma across different patient sub-populations, in terms of designing a larger phase II or pivotal phase III study. * Determine the time to partial or complete response and rate of response (at weeks 6 and 12 or at end of treatment and follow-up) in patients receiving interferon gamma. * Compare the proportion of patients with at least a two-fold reduction in the galactomannan antigenemia titer at 6 and 12 weeks or at end of treatment with these regimens. * Determine surrogate immunologic markers for response to interferon gamma, functional integrity and anti-fungal activity of phagocytic cells (neutrophils, monocytes, and macrophages), and nonphagocytic effector cells (natural killer and T cells) in these patients. OUTLINE: This is a randomized, double-blind, multicenter, pilot study. Patients are stratified according to age (under 18 vs 18 and over) and absolute neutrophil count (less than 500/mm\^3 vs at least 500/mm\^3). Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients receive voriconazole (IV over 80-120 minutes for the first 3 doses and orally every 12 hours for subsequent doses) 3 times per week and interferon gamma subcutaneously (SC) 3 times per week. * Arm II: Patients receive voriconazole as in arm I and placebo SC 3 times per week. In both arms, treatment continues for 12 weeks in the absence of disease progression or unacceptable toxicity. Patients are followed at 4 weeks. PROJECTED ACCRUAL: A total of 88 patients (44 per treatment arm) will be accrued for this study.
Interventions
BIOLOGICALrecombinant interferon gamma
DRUGvoriconazole
Sponsors
National Cancer Institute (NCI)
Study design
Allocation
RANDOMIZED
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE
Eligibility
Sex/Gender
ALL
Age
2 Years to No maximum
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Proven or probable invasive aspergillosis or other filamentous fungal infection by cytology, histopathology, or culture within the past 7 days * Presenting with 1 of the following: * Cancer * Aplastic anemia * Inherited immunodeficiencies * Autoimmune deficiency disorders * Acquired immunodeficiencies * Recipient of autologous peripheral blood stem cell or bone marrow transplantation * CNS aspergillosis or other filamentous fungal infection allowed * No invasive zygomycosis infection PATIENT CHARACTERISTICS: Age * 2 and over Performance status * Not specified Life expectancy * At least 7 days Hematopoietic * Not specified Hepatic * ALT no greater than 5 times upper limit of normal Renal * Creatinine clearance at least 30 mL/min Other * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective barrier contraception * No prior significant CNS disorder (e.g., multiple sclerosis or uncontrolled seizures) * No prior grade 3 or 4 toxicity or severe allergic reaction to interferon gamma * No prior intolerance or hypersensitivity to voriconazole or other azoles * No acute or chronic graft-versus-host disease * No conditions that would preclude study compliance PRIOR CONCURRENT THERAPY: Biologic therapy * See Disease Characteristics * No prior allogeneic peripheral blood or bone marrow transplantation * No concurrent interferon alfa Chemotherapy * Not specified Endocrine therapy * Not specified Radiotherapy * Not specified Surgery * No prior solid organ transplantation Other * Prior voriconazole allowed * At least 24 hours since prior administration of any of the following: * Astemizole * Cisapride * Pimozide * Quinidine * Sirolimus * Terfenadine * Rifabutin * Ergot alkaloids * Sildenafil citrate * Amiodarone * Flecainide * Systemic lidocaine * More than 14 days since prior long-acting barbiturates, carbamazepine, or rifampin * No other concurrent systemic antifungal drugs * No other concurrent investigational agents
Countries
United States
Outcome results
None listed