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Report of the US Suramin Working Group

Bruce D. Cheson, MD; Alexandra M. Levine, MD; Donna Mildvan, MD; Lawrence D. Kaplan, MD; Peter Wolfe, MD; Adan Rios, MD; Jerome E. Groopman, MD; Parkash Gill, MD; Paul A. Volberding, MD; Bernard J. Poiesz, MD; Michael S. Gottlieb, MD; Howard Holden, PhD; David J. Volsky, PhD; Suzanne S. Silver, MS; Michael J. Hawkins, MD

JAMA. 1987;258(10):1347-1351.

Abstract
Suramin sodium is a reverse transcriptase inhibitor with in vitro activity against the human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS). Ninety-eight patients with AIDS manifest as opportunistic infections (n = 38), AIDS with Kaposi's sarcoma (n = 38), AIDS-related complex (n = 20), or AIDS-associated non-Hodgkin's lymphoma (NHL) (n = 2) were treated with suramin sodium at 0.5,1.0, or 1.5 g/wk for six weeks followed by maintenance therapy with 0.5 or 1.0 g/wk. Of 72 patients who were HIV culture positive before therapy and were assessable for subsequent HIV culture 40% became culture negative during treatment, with no apparent correlation between virus recovery and serum suramin concentration. No immunologic improvement was noted. One complete clinical remission was noted in a patient with Kaposi's sarcoma and stage IV NHL. Seven minor clinical responses were also noted. Toxic reactions were generally reversible, and included fever (78%), rash (48%), malaise (43%), nausea (34%), neurologic symptoms (33%), and vomiting (20%). Suramin-induced neutropenia was noted in 26%, thrombocytopenia in 12%, a serum creatinine level of 180 µmol/L or higher (2.1 mg/dL) in 12%, liver dysfunction in 14%, and clinical and/or laboratory evidence of adrenal insufficiency in 23%. Sixteen patients died while receiving suramin or within three weeks of discontinuation of drug therapy due to infection (n = 6), hepatic failure (n = 3), pulmonary Kaposi's sarcoma (n = 2), AIDS encephalitis (n = 2), AIDS-associated NHL (n = 1), iatrogenic hemopneumothorax (n = 1), or pulmonary disease of uncertain etiology. Suramin as currently administered cannot be recommended as effective therapy for AIDS.

(JAMA 1987;258:1347-1351)

Author Affiliations
From the Cancer Therapy Evaluation Program, Division of Cancer Treatment, National Cancer Institute, Bethesda, Md (Drs Cheson, Holden, and Hawkins); the Division of Hematology, University of Southern California (Drs Levine and Gill), and the Division of Clinical Immunology and Allergy, Department of Medicine, University of California (Drs Wolfe and Gottlieb), Los Angeles; the Division of Infectious Diseases, Beth Israel Medical Center, New York (Dr Mildvan); the Division of Oncology and AIDS Activities, San Francisco General Hospital (Drs Kaplan and Volberding); the M. D. Anderson Hospital and Tumor Institute, Houston (Dr Rios); the Division of Hematology/Oncology, New England Deaconess Hospital, Harvard Medical School, Boston (Dr Groopman); the Hematology/Oncology Division, State University of New York, and the Veterans Administration Medical Center, Syracuse, NY (Dr Poiesz); the Molecular Biology Laboratory, University of Nebraska Medical Center, Omaha (Dr Volsky); and Social and Scientific Systems Inc, Bethesda, Md (Ms Silver). Dr Holden is now with Centocor, Inc, Malvern, Pa. Dr Rios is now with the Institute for Immunologic Disorders, Houston. Dr Volsky is now with the Molecular Virology Laboratory, Departments of Pediatrics and Medicine, St Luke's/Roosevelt Hospital Center, New York.

Footnotes
Reprint requests to Cancer Therapy Evaluation Program, Division of Cancer Treatment, National Cancer Institute, 7910 Woodmont Ave, Room 4A-18, Bethesda, MD 20892 (Dr Cheson).

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