AIDS-Related Kaposi Sarcoma, Human Immunodeficiency Virus 1 Positive
Conditions
Brief summary
This pilot phase I trial studies how well treatment with vincristine and bleomycin affect quality of life in patients with acquired immunodeficiency syndrome (AIDS)-associated Kaposi sarcoma.
Detailed description
PRIMARY OBJECTIVES: I. To evaluate the longitudinal quality of life of participants with human immunodeficiency virus (HIV)-associated Kaposi sarcoma (KS) during treatment with bleomycin sulfate (bleomycin) and vincristine sulfate (vincristine) at a single institution in East Africa. SECONDARY OBJECTIVES: II. To explore baseline and time-dependent correlates of improvements in quality of life (QOL). TERTIARY OBJECTIVES: III. To assess quality control (completeness and accuracy) in data capture of adverse events, clinical benefit, and objective response for site evaluation and training purposes. OUTLINE: Patients receive vincristine intravenously (IV) over 1-2 minutes and bleomycin IV over 10 minutes on day 1. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed for 12 weeks.
Interventions
BIOLOGICALBleomycin Sulfate
Given IV
OTHERLaboratory Biomarker Analysis
Correlative studies
OTHERQuality-of-Life Assessment
Ancillary studies
OTHERQuestionnaire Administration
Ancillary studies
DRUGVincristine Sulfate
Given IV
Sponsors
AIDS Malignancy Consortium
National Cancer Institute (NCI)
The Emmes Company, LLC
University of Arkansas
University of California, Los Angeles
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* HIV-1 infection, documented by any licensed rapid HIV test or HIV enzyme or chemiluminescence immunoassay (E/CIA) test kit at any time prior to study entry and confirmed by a licensed Western blot or a second antibody test by a method other than the initial rapid HIV and/or E/CIA, or by HIV-1 antigen, plasma HIV-1 ribonucleic acid (RNA) viral load * NOTE: the term "licensed" refers to a United States (U.S.) FDA-approved kit or for sites located in countries other than the U.S., a kit that has been certified or licensed by an oversight body within that country and validated internally * World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) guidelines mandate that confirmation of the initial test result must use a test that is different from the one used for the initial assessment; a reactive initial rapid test should be confirmed by either another type of rapid assay or an E/CIA that is based on a different antigen preparation and/or different test principle (e.g., indirect versus competitive), or a Western blot or a plasma HIV-1 ribonucleic acid (RNA) viral load * Participants must have pathologically confirmed Kaposi sarcoma * Participants should not have had prior therapy for their Kaposi sarcoma * All participants must be on stable antiretroviral therapy (ART) for a minimum of 12 weeks prior to study entry with an acceptable regimen that adheres to national guidelines for treatment of HIV infection * Eastern Cooperative Oncology Group (ECOG) performance status =\< 2 (Karnofsky performance status \>= 50%) * Leukocytes: \>= 3,000/mm\^3, within 7 days of enrollment * Absolute neutrophil count: \>= 1,000/mm\^3, within 7 days of enrollment * Hemoglobin \>= 8 g/dL, within 7 days of enrollment * Platelets: \>= 75,000/mm\^3, within 7 days of enrollment * Direct bilirubin: \< 3 mg/dL, within 7 days of enrollment * Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\]) / alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase \[SGPT\]): =\< 2.5 x institutional upper limit of normal, within 7 days of enrollment * Creatinine: * Creatinine levels within normal institutional limits, within 7 days of enrollment; or, * Creatinine clearance \>= 60 mL/min/1.73 m\^2 for participants with creatinine levels above institutional normal, within 7 days of enrollment * Participants with serious chronic, acute, or recurrent infections must have completed at least 14 days of therapy prior to study entry and be clinically stable * If the participant is a female of childbearing potential (FCBP), defined as a sexually mature woman who: (1) has not undergone a hysterectomy or bilateral oophorectomy, or (2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months), the participant must have a negative urine or serum pregnancy test within 1 week prior to enrollment and agree to use an effective form of contraception (e.g., barrier contraception or hormonal contraception), during the 5 months of planned chemotherapy treatment and for 6 months after completing treatment * Ability to understand and the willingness to sign a written informed consent document
Exclusion criteria
* Participants who are receiving any other investigational agents * Participants with known brain metastases * History of allergic reactions attributed to compounds of similar chemical or biologic composition to bleomycin or vincristine * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements * Participants who are breastfeeding a child; breastfeeding should be discontinued if the mother is treated with this chemotherapy * Current or history of known pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), emphysema, bronchiectasis, or diffuse or significant local radiographic interstitial infiltrates on chest x-ray (CXR) or computed axial tomography (CT) scan, that, in the opinion of the investigator, would exclude bleomycin use * NOTE: participants with an abnormal CXR or CT scan (which may indicate pulmonary KS) should undergo screening evaluations to rule out an infectious cause, per standard of care; if available, other diagnostic procedures such as bronchoscopy should be considered to confirm the presence or absence of pulmonary KS and/or an infectious agent; these procedures should be completed outside the study; these participants should be excluded if, in the opinion of the site investigator, use of bleomycin would be detrimental * Oxygen saturation less than 90% and/or exercise desaturation greater than 4% within 14 days before study enrollment * NOTE: exercise is defined as any activity that will increase a participant?s resting heart rate by at least 20 beats/minute
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Score on Quality of Life Assessed Using Functional Assessment of Cancer Therapy-General (FACT-G) Questionnaire | Up to 3 months after treatment completion | The four domains of the FACT-G questionnaire will be determined for each questionnaire: physical well-being, social/family well-being, emotional well-being, and functional well-being. Each of these four domains is scored on a subset of 6-7 statements with a 0-4 scale. The domain is scored by summing up the responses to these statements. The ranges for the domains are as follows: physical well-being 0-28, social/family well-being 0-28, emotional well-being 0-24, and functional well-being 0-28. Using general estimating equations, changes in these domains with time will be explored. Logistic regression analyses will be used to correlate changes in quality of life domains with clinical response. The overall score is the sum of all the subscales and ranges from 0 to 108. Higher scores reflect better quality of life outcomes. The FACT-G Total Score at 3 months is reported here |
Countries
Tanzania
Contacts
STUDY_CHAIRNestory Masalu
Bugando Medical Centre
STUDY_CHAIRKristin Schroeder
AIDS Malignancy Consortium
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Supportive Care (Vincristine Sulfate, Bleomycin Sulfate) Patients receive vincristine sulfate IV over 1-2 minutes and bleomycin sulfate IV over 10 minutes on day 1. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
Bleomycin Sulfate: Given IV
Laboratory Biomarker Analysis: Correlative studies
Quality-of-Life Assessment: Ancillary studies
Questionnaire Administration: Ancillary studies
Vincristine Sulfate: Given IV | 10 |
| Total | 10 |
Baseline characteristics
| Characteristic | Supportive Care (Vincristine Sulfate, Bleomycin Sulfate) |
|---|---|
| Age, Continuous | 44.7 years STANDARD_DEVIATION 16.4 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 10 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 0 Participants |
| Region of Enrollment Tanzania | 10 participants |
| Sex: Female, Male Female | 3 Participants |
| Sex: Female, Male Male | 7 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 10 |
| other Total, other adverse events | 0 / 10 |
| serious Total, serious adverse events | 0 / 10 |
Outcome results
Primary
Total Score on Quality of Life Assessed Using Functional Assessment of Cancer Therapy-General (FACT-G) Questionnaire
The four domains of the FACT-G questionnaire will be determined for each questionnaire: physical well-being, social/family well-being, emotional well-being, and functional well-being. Each of these four domains is scored on a subset of 6-7 statements with a 0-4 scale. The domain is scored by summing up the responses to these statements. The ranges for the domains are as follows: physical well-being 0-28, social/family well-being 0-28, emotional well-being 0-24, and functional well-being 0-28. Using general estimating equations, changes in these domains with time will be explored. Logistic regression analyses will be used to correlate changes in quality of life domains with clinical response. The overall score is the sum of all the subscales and ranges from 0 to 108. Higher scores reflect better quality of life outcomes. The FACT-G Total Score at 3 months is reported here
Time frame: Up to 3 months after treatment completion
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Supportive Care (Vincristine Sulfate, Bleomycin Sulfate) | Total Score on Quality of Life Assessed Using Functional Assessment of Cancer Therapy-General (FACT-G) Questionnaire | 56.9 score on a scale | Standard Deviation 11.7 |
Other Pre-specified
Clinical Data Collection Quality for Site Evaluation and Training Purposes
Time frame: Up to 1 year