Efficacy and safety of telavancin in the treatment ofram-positive bloodstream infections in cancer patients
Gram-positive bacteria are a leading cause of blood stream infections (BSI) in cancer patients. Televancin is a bactericidal glycopeptide which has not been compared to vancomycin in cancer patients with BSI. We therefore compared the clinical efficacy and safety of telavancin to vancomycin in cancer patients with gram-positive BSI.
Between March 2011 and May 2013, we enrolled 40 cancer patients (39 evaluable) with uncomplicated Gram-positive BSI who received intravenous telavancin for at least 14 days for S. aureus and 7 days for other Gram-positive cocci. Patients with baseline creatinine clearance (Cr Cl) > 50 ml/min received a daily dose of 10mg/kg and those with Cr Cl between 30-49 ml/min received a dose of 7.5 mg/kg. Patients were followed for 1 month after the last dose of study drug. These patients were compared with 39 historical matched control patients (based on underlying disease, type of organism and neutropenia) who were treated with vancomycin.
A total of 78 evaluable patients were analyzed, 39 patients in each group. The most common pathogens causing BSI were Staphylococcus aureus (n = 20), followed by alpha-hemolytic Streptococci (n=7), Enterococcus (n=7), coagulase-negative Staphylococcus (n=4), and beta-hemolytic Streptococci (n=1). 62% of patients had hematological malignancies and 51% were neutropenic at onset of bacteremia. There was a possible trend towards a better clinical response associated with telavancin compared with vancomycin (89% vs. 72%; p=0.09). Microbiological response was similar in both groups (telavancin 92% vs vancomycin 95%; p=0.67). Overall mortality and infectious-related mortality were comparable in both arms. Drug related averse events were similar in both groups (telavancin 26% vs. vancomycin 21%; p=0.59). Median creatinine levels and creatinine clearance at baseline, end-of-treatment and last follow-up visits were comparable in both groups.
Treatment with telavancin for gram-positive BSI in cancer patients was generally effective and safe and may provide a useful and convenient alternative to standard vancomycin therapy.
A. M. Chaftari,
M. Jordan, None
K. Garoge, None
Z. Al Hamal, None
A. El Zakhem, None
G. M. Viola, None
B. Granwwehr, None
A. Gagel, None
Y. Jiang, None
M. Al Shuaibi, None
I. Raad, Astellas: Grant Investigator, Grant recipient
Pfizer: Consultant, Consulting fee