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Chemoprevention of Anal Neoplasia Arising Secondary to Anogenital Human Papillomavirus Infection in Persons With HIV Infection.
This study has been completed.
First Received: November 2, 1999   Last Updated: August 1, 2008   History of Changes
Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)
Collaborator: Hoffmann-La Roche
Information provided by: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT00000764
  Purpose

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 Intervention Phase
HIV Infections
Anus Neoplasms
Drug: Isotretinoin
Drug: Interferon alfa-2a
Phase I

Study Type: Interventional
Study Design: Treatment, Randomized, Efficacy Study
Official Title: Chemoprevention of Anal Neoplasia Arising Secondary to Anogenital Human Papillomavirus Infection in Persons With HIV Infection.

Resource links provided by NLM:


Further study details as provided by National Institute of Allergy and Infectious Diseases (NIAID):

Estimated Enrollment: 98
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.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria

Concurrent Medication:

Allowed:

  • PCP prophylaxis (required for patients with CD4 count < 200 cells/mm3).
  • Chemoprophylaxis for candidiasis and herpes simplex.
  • Metronidazole for up to 14 days.
  • Erythropoietin.

Patients must have:

  • HIV seropositivity.
  • NO active opportunistic infection requiring treatment with prohibited drugs.
  • 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:

  • Active medical problems for which the patient is undergoing evaluations or for which prohibited therapy is required.
  • Other active malignancies requiring systemic therapy.
  • 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:

  • G-CSF (filgrastim).
  • Myelosuppressive antibiotics (except co-trimoxazole for PCP prophylaxis).
  • Corticosteroids.
  • Biologic response modifiers.
  • 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:

  • G-CSF (filgrastim).
  • Myelosuppressive antibiotics (except co-trimoxazole for PCP prophylaxis).
  • 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
Please refer to this study by its ClinicalTrials.gov identifier: NCT00000764

Locations
United States, California
San Francisco AIDS Clinic / San Francisco Gen Hosp
San Francisco, California, United States, 941102859
United States, Washington
Univ of Washington
Seattle, Washington, United States, 981224304
Sponsors and Collaborators
Hoffmann-La Roche
Investigators
Study Chair: Palefsky JM
Study Chair: Northfelt DW
Study Chair: Kaplan LD
Study Chair: Critchlow C
  More Information

Additional Information:
No publications provided

Study ID Numbers: ACTG 216
Study First Received: November 2, 1999
Last Updated: August 1, 2008
ClinicalTrials.gov Identifier: NCT00000764     History of Changes
Health Authority: United States: Federal Government

Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
Interferon Alfa-2a
Acquired Immunodeficiency Syndrome
AIDS-Related Complex
Anus Neoplasms
Papillomavirus, Human
Papovaviridae Infections
Tumor Virus Infections
Isotretinoin

Additional relevant MeSH terms:
Communicable Diseases
Anti-Infective Agents
Slow Virus Diseases
Rectal Neoplasms
Physiological Effects of Drugs
Rectal Diseases
Neoplasms by Site
Therapeutic Uses
Angiogenesis Modulating Agents
Dermatologic Agents
Digestive System Neoplasms
Immune System Diseases
Acquired Immunodeficiency Syndrome
Virus Diseases
Skin Diseases, Viral
Neoplasms
HIV Infections
Gastrointestinal Neoplasms
DNA Virus Infections
Interferon Alfa-2a
Anus Neoplasms
Sexually Transmitted Diseases, Viral
Immunologic Factors
Gastrointestinal Diseases
Antineoplastic Agents
Tumor Virus Infections
Infection
Isotretinoin
Growth Inhibitors
Retroviridae Infections

ClinicalTrials.gov processed this record on November 27, 2009