Daptomycin use in patients with cancer and neutropenia: data from a retrospective registry.
Clinical data for daptomycin in the treatment of neutropenic cancer patients with documented gram-positive infections are limited. For this study, neutropenic patients were identified from an ongoing retrospective registry (Cubicin Outcome Registry and Experience [CORE]; 2006 program year). Clinical outcomes included cure, improved, failed, and nonevaluable response, and were assessed at the end of daptomycin therapy. Patients who had a nonevaluable clinical response were only included in the safety analysis. Eighty-four patients were identified, of which 72 (86%) were clinically evaluable. Thirty-four (47%) evaluable patients had severe neutropenia (less than 100 cells/mm(3)). Hematologic malignancies were most common (82%). Bacteremia was the most common infection (76%), and vancomycin-resistant enterococci (50%), coagulase-negative staphylococci (24%), and Staphylococcus aureus (11%) were the most common pathogens isolated. Sixty-three patients (88%) received prior antibiotics, including vancomycin (83%), cefepime (17%), and linezolid (16%). The overall success rate (cure + improved) was 90%. Success rates stratified by degree of neutropenia were 85% for patients with less than 100 cells/mm(3), 93% for those with 100-499 cells/mm(3), and 100% for those with 500-1,000 cells/mm(3). The median final daptomycin dose was 6 mg/kg (range, 3-8) and the median duration of therapy was 13 days (range, 1-86). Of the 84 patients analyzed for safety, 24 (29%) developed 44 adverse events; only 5 (6%) patients had adverse events possibly related to daptomycin. The results suggest that daptomycin may be useful for specific cases involving neutropenic patients, and comparative clinical trials are feasible.
Rolston
Kenneth V I
KV
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. krolston@mdanderson.org
McConnell
Scott A
SA
Brown
Jack
J
Lamp
Kenneth C
KC
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017576:Daptomycin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000188:drug therapy*; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D017576:Daptomycin