Chemoprevention of Anal Neoplasia Arising Secondary to Anogenital Human Papillomavirus Infection in Persons With HIV Infection.
Study Details
Study Description
Brief Summary
PRIMARY: In Phase I, to define a broadly tolerable dose of isotretinoin that can be used in combination with interferon alfa-2a (IFN alfa-2a). In Phase II, to determine trends in efficacy of isotretinoin alone or in combination with IFN alfa-2a as chemoprevention (preventing progression or recurrence) of anal intraepithelial neoplasia ( AIN ) / squamous intraepithelial lesions ( SIL ) in patients with HIV infection.
SECONDARY: To evaluate the effects of isotretinoin alone or in combination with IFN alfa-2a on immune function markers, human papillomavirus (HPV) type, and HPV DNA levels.
Patients with HIV infection have a significant risk of recurrence following local ablation of intraepithelial neoplasia; thus, anogenital epithelial may become an increasingly important cause of morbidity, and possibly mortality, as the HIV epidemic matures. Clinical studies of non-HIV-infected subjects have established that synthetic retinoids inhibit the progression of epithelial preneoplastic conditions and some neoplastic states.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 1 |
Detailed Description
Patients with HIV infection have a significant risk of recurrence following local ablation of intraepithelial neoplasia; thus, anogenital epithelial may become an increasingly important cause of morbidity, and possibly mortality, as the HIV epidemic matures. Clinical studies of non-HIV-infected subjects have established that synthetic retinoids inhibit the progression of epithelial preneoplastic conditions and some neoplastic states.
In the Phase I portion of the study, 20 patients per site each receive isotretinoin in escalating doses. If a patient experiences grade 2 or worse toxicity (or grade 3 or worse hypertriglyceridemia), dose is reduced to the previously tolerated dose for the remainder of the 6 week period. Patients are then reassessed for anal neoplasia; those with no progression and no grade 2 or worse toxicity receive an additional 6 weeks of isotretinoin in combination with interferon alfa-2a. For Phase II of the study, a separate group of patients who have undergone ablative therapy are randomized to one of three arms (26 patients/arm): isotretinoin alone at the dose tolerated by at least 60 percent of patients in Phase I; isotretinoin plus interferon alfa-2a; or observation only. Treatment continues for 48 weeks.
Study Design
Outcome Measures
Primary Outcome Measures
Eligibility Criteria
Criteria
Inclusion Criteria
Concurrent Medication:
Allowed:
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PCP prophylaxis (required for patients with CD4 count < 200 cells/mm3).
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Chemoprophylaxis for candidiasis and herpes simplex.
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Metronidazole for up to 14 days.
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Erythropoietin.
Patients must have:
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HIV seropositivity.
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NO active opportunistic infection requiring treatment with prohibited drugs.
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Phase I - Current grade 1 AIN (i.e., low grade SIL) OR treated or untreated grade 2 or 3 AIN (i.e., high grade SIL).
Phase II - Prior histologically confirmed grade 2 or 3 AIN / high grade SIL, with ablative therapy within the past 30-90 days.
- Capability of complying with study protocol.
NOTE:
- The terms condyloma, grade 1 AIN, and low grade SIL are interchangeable. Grade 2 or 3 AIN is interchangeable with high grade SIL.
Exclusion Criteria
Co-existing Condition:
Patients with the following symptoms or conditions are excluded:
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Active medical problems for which the patient is undergoing evaluations or for which prohibited therapy is required.
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Other active malignancies requiring systemic therapy.
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Significant symptomatic cardiac disease.
NOTE:
- Patients with malignancies being managed with local therapy (e.g., Kaposi's sarcoma, basal cell carcinoma) may enroll at the discretion of the site investigator.
Concurrent Medication:
Excluded:
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G-CSF (filgrastim).
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Myelosuppressive antibiotics (except co-trimoxazole for PCP prophylaxis).
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Corticosteroids.
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Biologic response modifiers.
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Cytotoxic chemotherapy.
Concurrent Treatment:
Excluded:
- Radiation therapy.
Patients with the following prior conditions are excluded:
History of ventricular arrhythmias or myocardial infarction.
Prior Medication:
Excluded within 20 days prior to study entry:
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G-CSF (filgrastim).
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Myelosuppressive antibiotics (except co-trimoxazole for PCP prophylaxis).
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Corticosteroids.
-
Biologic response modifiers.
-
Cytotoxic chemotherapy.
Prior Treatment:
Excluded within 20 days prior to study entry:
- Radiation therapy.
Excluded within 14 days prior to study entry:
- Transfusion.
Active substance abuse or illegal drug use (alcohol consumption is strongly discouraged).
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | University of Washington AIDS CRS | Seattle | Washington | United States | 98122 |
Sponsors and Collaborators
- National Institute of Allergy and Infectious Diseases (NIAID)
- Hoffmann-La Roche
Investigators
- Study Chair: Palefsky JM,
- Study Chair: Northfelt DW,
- Study Chair: Kaplan LD,
- Study Chair: Critchlow C,
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- ACTG 216
- 11193