Alternate Title
Basic Trial Information
Objectives
Entry Criteria
Expected Enrollment
Outcomes
Outline
Trial Contact Information
Registry Information

Alternate Title

Early Hospital Discharge or Standard Inpatient Care in Cancer Patients Receiving Antibiotics for Febrile Neutropenia

Basic Trial Information

Phase	Type	Status	Age	Sponsor	Protocol IDs
Phase III	Health services research, Supportive care	Active	18 and over	Other	CRUK-MX3006 CRUK-ORANGE, ISRCTN18467252, EU-20707, NCT00445497

Objectives

1. Identify cancer patients who are low-risk inpatients and meet criteria for early discharge (i.e., symptomatic improvement and temperature ≤ 37.8°C) after receiving oral antibiotics for febrile neutropenia.

Entry Criteria

Disease Characteristics:

• Diagnosis of solid tumor or lymphoma AND meets the following criteria:
  • Low-risk patient, defined as Multinational Association for Supportive Care in Cancer prognostic index score ≥ 21
  • Presents with neutropenic fever defined as follows:
    • Absolute neutrophil count ≤ 500/mm³ OR < 1,000/mm³ but anticipated to fall to ≤ 500/mm³ within 24 hours of study entry
    • Temperature ≥ 38.5°C on a single measurement or ≥ 38.0°C on > 1 occasion (one of which could be measured by the patient prior to admission) ≥ 1 hour apart
  • Undergoing concurrent cytotoxic chemotherapy for treatment of solid tumors or lymphoma
• No leukemia

Prior/Concurrent Therapy:

• See Disease Characteristics
• No prior participation in this study for neutropenic episode
• No prior bone marrow transplantation or peripheral blood stem cell transplantation
• No prior treatment for leukemia
• More than 72 hours since prior antibiotics, including prophylactic antibiotics
  • Prophylactic septrin (for pneumocystis), acyclovir, or antifungals are allowed
• No concurrent granulocyte colony-stimulating factor therapy

Patient Characteristics:

• Compliant and appropriate for early discharge
• Able to read a thermometer (patient or caregiver)
• Able to tolerate oral medication
• Must have a responsible adult caregiver if eligible for early discharge
• No known allergy to oral antibiotics or penicillin
• No requirement for IV fluid support
• No central venous catheter-associated infection or evidence of infection not amenable to treatment by study antibiotics
• No neutropenic fever at high risk of complications
• No associated comorbidity that requires hospitalization and management
• No known HIV positivity

Expected Enrollment

A total of 400 patients will be accrued for this study.

Outcomes

Total number of days of hospitalization (including unplanned readmission) (randomized patients)
Incidence of serious adverse events (randomized and registered patients)

Incidence of treatment failure as defined by the necessity for change in antibiotic therapy (randomized and registered patients)
Incidence of unplanned readmissions (randomized patients)
Patient acceptability of randomized discharge policy as measured by Health Questionnaire, Cancer Worries Inventory Booklet, and Patient Daily Diary (randomized patients)
Toxicity attributed to oral antibiotic therapy as measured by NCI CTCAE v3.0 (randomized and registered patients)
Health service costs (randomized patients)

Outline

This is a randomized, prospective, multicenter study. Patients are stratified by disease type (lymphoma vs solid tumor), duration of registration (< 48 hours vs > 48 hours), and participating center.

Patients receive oral amoxicillin-clavulanate potassium 3 times daily and oral ciprofloxacin twice daily on admission to the hospital. Treatment continues for 7 days in the absence of clinical deterioration or unacceptable toxicity. Patients are assessed as inpatients after ≥ 24 and up to 72 hours after the first antibiotic dose. Patients showing clear response (i.e., symptomatic improvement irrespective of neutrophil recovery, temperature ≤ 37.8 C for 24 hours) and who continue to meet study eligibility criteria are randomized to 1 of 2 arms.

• Arm I (early discharge): Patients are discharged home and instructed to remain in daily contact with hospital staff to report temperature and symptoms until completion of oral antibiotic regimen.
• Arm II (standard management): Patients continue their antibiotic course in hospital and are discharged according to local guidelines and the following additional criteria: subjective improvement, afebrile (≤ 37°C for 24 hours), and absolute neutrophil count ≥ 500/mm³ and rising.

Patients in both arms complete a daily diary documenting daily temperature readings, symptoms, and toxicities. Patients also complete a Health Questionnaire and a Cancer Worries Inventory Booklet at baseline, in the hospital immediately after randomization, and at completion of oral antibiotics or resolution of neutropenic febrile episode.

Peer Reviewed and Funded or Endorsed by Cancer Research UK

Trial Contact Information

Trial Lead Organizations

Clatterbridge Centre for Oncology

Ernest Marshall, MD, Protocol chair		Ph: 44-151-334-1155

United Kingdom
England
	Cheltenham
	Gloucestershire Oncology Centre at Cheltenham General Hospital
		Contact Person	Ph:  44-0124-2222-2222
	Hull
	Princess Royal Hospital at Hull and East Yorkshire NHS Trust
		Contact Person	Ph:  44-0148-2701151
	Leicester
	Leicester Royal Infirmary
		Contact Person	Ph:  44-011-6254-1414
	Merseyside
	Clatterbridge Centre for Oncology
		Ernest Marshall, MD	Ph:  44-151-334-1155
	Northampton
	Northampton General Hospital NHS Trust
		Contact Person	Ph:  44-016-0463-4700
	Peterborough
	Peterborough Hospitals Trust
		Contact Person	Ph:  44-0173-387-4000
	Sheffield
	Cancer Research Centre at Weston Park Hospital
		Contact Person	Ph:  44-114-226-5000
	West Yorkshire
	Airedale General Hospital
		Contact Person	Ph:  44-015-356-2511
Scotland
	Glasgow
	Western Infirmary
		Contact Person	Ph:  44-0114-226-5000
Wales
	Bangor
	Ysbyty Gwynedd
		Contact Person	Ph:  44-0124-838-4384

Registry Information
Official Title		A Prospective Randomised Phase III Trial of Early Hospital Discharge Versus Standard Inpatient Management of Cancer Patients with Low-Risk Febrile Neutropenia Receiving Oral Antibiotics. Oral Antibiotics for Neutropenic Sepsis Giving Early Hospital Discharge [ORANGE]
Trial Start Date		2007-07-16
Trial Completion Date		2010-07-16 (estimated)
Registered in ClinicalTrials.gov		NCT00445497
Date Submitted to PDQ		2007-01-25
Information Last Verified		2007-05-30

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