Empiric Therapy of Patients With Persistent Fever and Agranulocytosis Using Caspofungin

Caspofungin, a member of the new echinocandin class of compounds，had been proved as effective as and generally better tolerated than liposomal amphotericin B when given as empirical antifungal therapy in patients with persistent fever and neutropenia，and It was approved by FDA in 2001.The generics caspofungin of Chia Tai TianQing Pharmaceutical Group Co. , Ltd. (CTTQ) will be approved by CFDA.The purpose of this study is evaluating the efficacy and safety of this generics caspofungin in the empirical antifungal therapy in patients with persistent fever and neutropenia.

This is a prospective,multicenter,randomized,controlled,open label study,the designed cases are 60 subjects.This study is divided into two stages,one is pharmacokinetics study stage ,the purpose of this stage is comparing the blood concentration of generics caspofungin and original medicine(Cancidas®) ,24 of 60 subjects will participate in this stage,the randomization in a 1:1 ratio will be performed at each group.The other 36 subjects will participate in another stage that is a single study,all subjects will use generics caspofungin.

Inclusion criteria

• Age 18-70 years old
• The neutrophil counts of the patients with leukemia, lymphoma or other tumors undergoing chemotherapy or receiving hematopoietic stem cell transplantation are below 500 million/L for 96 hours at least,as well as the body temperatures are over 38.0 °C;
• It is ineffective using intravenous broad-spectrum antibacterial therapy lasting at least 96h;
• Estimated survival period > 3 months;
• Subjects voluntarily participate in the study and sign informed consent.

Exclusion criteria

• The subjects did not receive adequate antibacterial therapy;
• The subjects were received other antifungal medications within 14 days (except for fluconazole prophylaxis);
• It was confirmed or clinically diagnosed as invasive fungal infection;
• Subjects with liver dysfunction (ALT, AST exceeds the upper limit of normal value by 2 times);
• Subjects with renal insufficiency (Cr, BUN exceeds the upper limit of the normal value of 1.5 times);
• Subjects are allergic to the investigational product;
• Pregnant or lactating women;
• Simultaneous treatment with cyclosporine, tacrolimus, rifampicin, efavirenz, nevirapine, dexamethasone, phenytoin or carbamazepine;
• Other circumstances that investigators believe unsuitable for enrollment; （criteria 8 does not apply to Phase 2）