Steven A. Miles, MD; HeJing Wang, MD; Eduardo Cortes, MD; Judy Carden, RN; Stephen Marcus, MD; Ronald T. Mitsuyasu, MD
Study Objective: To study the efficacy of high doses of beta-ser-interferon (recombinant human 17-serine beta-interferon) in patients with human immunodeficiency virus (HIV) infection and Kaposi sarcoma.
Design: A nonrandomized, controlled trial of two high-dose regimens of beta-ser-interferon administered until tumor progression, toxicity, or an acquired immunodeficiency syndrome (AIDS)-defining opportunistic infection occurred.
Setting: An AIDS treatment clinic at a tertiary care center.
Patients: A sequential sample of 39 patients with biopsy-proven, AIDS-related Kaposi sarcoma were enrolled during a 2-year period. Thirty-eight patients were evaluable for response. Most patients (35 of 38) had one or more of the following clinical or laboratory predictors for a poor response to interferon therapy: HIV p24 antigenemia, low CD4 cell numbers, elevated beta2-microglobulin levels, previous opportunistic infections, or previous systemic chemotherapy.
Interventions: Beta-ser-interferon was self-administered subcutaneously at home 5 days per week. The first 21 patients used 90 million IU/d, and the remainder used 180 million IU/d.
Measurements and Main Results: Six patients (16%) had a major clinical response, and 15 (39%) had stable disease for prolonged periods. Toxicities were minimal; the major toxicity was a skin reaction at the injection site. The HIV p24 antigen level declined more than 50% in 8 of the 19 patients with initial values greater than 50 pg/mL. Antiretroviral activity and antitumor activity were seen only in patients with normal initial beta2-microglobulin levels. Minimal changes were seen in CD4 and CD8 cell numbers. Only 1 patient had an opportunistic infection while on study, but five other patients developed infections after treatment was discontinued for an incidence of six opportunistic infections in 285 patient-observation months.
Conclusions: The high doses of interferon did not improve the major response rate in patients with poor-prognosis, AIDS-related Kaposi sarcoma. There was, however, a suggestion of antiviral activity in patients with normal beta2-microglobulin levels and a decrease in the expected incidence of opportunistic infections.
Miles SA, Wang H, Cortes E, et al. Beta-Interferon Therapy in Patients with Poor-Prognosis Kaposi Sarcoma Related to the Acquired Immunodeficiency Syndrome (AIDS): A Phase II Trial with Preliminary Evidence of Antiviral Activity and Low Incidence of Opportunistic Infections. Ann Intern Med. 1990;112:582–589. doi: 10.7326/0003-4819-112-8-582
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Published: Ann Intern Med. 1990;112(8):582-589.
Hematology/Oncology, Infectious Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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