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RATIONALE: Keratinocyte growth factor may prevent symptoms of mucositis in patients receiving radiation therapy and chemotherapy.
PURPOSE: Randomized phase II trial to study the effectiveness of keratinocyte growth factor in preventing oral mucositis in patients who have hematologic cancers and who are undergoing radiation therapy and chemotherapy before autologous peripheral stem cell transplantation.
OBJECTIVES: I. Determine the efficacy of recombinant keratinocyte growth factor in reducing the duration of severe oral mucositis induced by total body irradiation and high dose chemotherapy in patients with hematologic malignancies. II. Determine the incidence and duration of severe oral mucositis, grade 2-4 diarrhea, and febrile neutropenia in these patients. III. Determine the necessity of use of transdermal or parenteral opioid analgesics and IV antifungals or antibiotics for febrile neutropenia or infections in these patients. IV. Determine the quality of life of these patients.
OUTLINE: This is a randomized, double blind, placebo controlled, multicenter study. Patients are stratified by center. Patients are randomized to one of three treatment arms. Arm I: Patients receive 7 doses of recombinant human keratinocyte growth factor (rHuKGF). Arm II: Patients receive 4 doses of rHuKGF followed by 3 doses of placebo. Arm III: Patients receive 7 doses of placebo. Patients receive one of two conditioning regimens. Primary conditioning regimen: Patients receive rHuKGF or placebo daily on days -11, -10, -9, -5, 0, 1, and 2. Total body irradiation (TBI) is administered twice a day on days -8 to -5. Patients receive etoposide on day -4, cyclophosphamide IV over 1 hour on day -2, and peripheral blood stem cell transplantation (PBSCT) on day 0. Filgrastim (G-CSF) IV or SC is administered beginning on day 0 and continuing for 21 days or until blood counts recover. Secondary conditioning regimen: Patients receive rHuKGF or placebo daily on days -13, -12, -11, -7, 0, 1, and 2. TBI is administered twice a day on days -10 to -7. Patients receive ifosfamide IV over 1 hour followed by etoposide over 23 hours on days -6 to -2, then PBSCT on day 0. G-CSF IV or SC is administered beginning on day 0 for 21 days or until blood counts recover. Quality of life is assessed daily beginning on day -11 and continuing until day 28. Patients are followed at day 28 and then at day 60-100.
PROJECTED ACCRUAL: A minimum of 111 patients (37 per arm) will be accrued for this study.
Allocation: Randomized, Primary Purpose: Supportive Care
Drug/Agent Toxicity by Tissue/Organ
filgrastim, palifermin, cyclophosphamide, etoposide, ifosfamide, quality-of-life assessment, radiation therapy
Jonsson Comprehensive Cancer Center, UCLA
National Cancer Institute (NCI)
Published on BioPortfolio: 2014-08-27T03:58:21-0400
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Positional isomer of CYCLOPHOSPHAMIDE which is active as an alkylating agent and an immunosuppressive agent.
A semisynthetic derivative of PODOPHYLLOTOXIN that exhibits antitumor activity. Etoposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA. This complex induces breaks in double stranded DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent entry into the mitotic phase of cell division, and lead to cell death. Etoposide acts primarily in the G2 and S phases of the cell cycle.
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