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Isavuconazole in Preventing Invasive Fungal Infections in Adult Patients With Newly Diagnosed Acute Myeloid Leukemia or Myelodysplastic Syndrome and Neutropenia

Primary Purpose

Acute Myeloid Leukemia, Myelodysplastic Syndrome, Neutropenia

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Isavuconazole
Sponsored by
M.D. Anderson Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Acute Myeloid Leukemia

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients with either newly diagnosed AML or MDS who have either begun (within 4 days of starting study drug) or are planned to begin specific treatment for their AML/MDS; hydroxyurea and cytarabine used for cytoreduction while awaiting initiation of definitive therapy are not considered "specific" treatment; patients who are participating in other therapeutic clinical trials for their AML/MDS may participate in this trial
  • Patients must have or be anticipated to have neutropenia (absolute neutrophil count [ANC] < 0.5 x 10^9/L) (75) for >= 7 days as a result of treatment of their AML/MDS
  • Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2
  • Total bilirubin =< 3 x upper limit of normal (ULN)
  • Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 5 x ULN
  • Patients must be able to take oral medications, although a brief period of IV therapy (< 4 days) is permitted at trial entry
  • Patients must be willing and able to provide written informed consent for the trial
  • Women of childbearing potential (WOCBP) must practice 2 effective methods of birth control during the course of the study; male patients who are partners of WOCBP should also practice an effective method of contraception; effective methods of birth control include diaphragm or condoms with spermicidal foam or jelly, birth control pills (BCPs), injections or patches, intra-uterine devices (IUDs) and surgical sterilization
  • Postmenopausal women must be amenorrheic for >= 12 months to be considered of non-childbearing potential
  • Women and men must continue birth control for the duration of the trial and >= 3 months after the last dose of study drug
  • All WOCBP MUST have a negative pregnancy test prior to first receiving study medication

Exclusion Criteria:

  • Proven, probable or possible IFI within the previous 30 days
  • Use of any systemic antifungal therapy for > 72 hours during the week prior to study drug initiation
  • History of hypersensitivity or idiosyncratic reactions to azoles
  • Patients with familial short QT syndrome or with corrected QT (QTc) interval =< 300 ms
  • Patients on strong CYP3A4 inducers or inhibitors that cannot be discontinued
  • Women who are pregnant or nursing, or intend to be/do so during the course of the study
  • Patients with severe hepatic impairment (Child-Pugh class C)
  • Patients with known or suspected Gilbert's syndrome at the time of study enrollment
  • Patients with known gastrointestinal conditions that could potentially interfere with absorption of orally administered medications
  • Any condition that, in the opinion of the investigator, may interfere with the objectives of the study, e.g., any condition requiring the use of prohibited drugs or unstable medical conditions other than AML/MDS, such as a cardiac or neurologic disorder expected to be unstable or progressive during the course of the study (e.g., seizures or demyelinating syndromes, acute myocardial infarction within 3 months of study entry, myocardial ischemia or unstable congestive heart failure, unstable arrhythmias)

Sites / Locations

  • M D Anderson Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Prevention (isavuconazole)

Arm Description

Patients receive isavuconazole PO every 8 hours for 6 doses and then Once a day (QD) or IV over 1 hour every 8 hours for 6 doses and then QD for up to 4 days for 12 weeks in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Number of Participants With Proven or Probable Invasive Fungal Infections (IFIs)
Participants with proven or possible invasive fungal infections.

Secondary Outcome Measures

Number of Participants With Invasive Aspergillosis
Participants with invasive aspergillosissured.
Number of Participants With Other Invasive Fungal Infections (IFIs)
Participants with other IFIs will be measured.
Number of Participants With Treatment Success
Will evaluate versus (vs.) failure (defined as Participants with proven or probable IFI, receipt of any other systemic antifungal agent for +/- 4 days for suspected IFI, occurrence of an adverse events possibly or probably related to the study drug resulting in discontinuation of treatment, or withdrawal from the study with no additional follow-up).
Number of Participants Who Failed Treatment
Will evaluate versus success. Success is defined as Participants with proven or probable IFI, receipt of any other systemic antifungal agent for +/- 4 days for suspected IFI, occurrence of an adverse events possibly or probably related to the study drug resulting in discontinuation of treatment, or withdrawal from the study with no additional follow-up).
Overall Survival (OS)
Time from date of treatment start until date of death due to any cause or last Follow-up.
Invasive Fungal Infections (IFIs)-Free Survival
Time measured in days from start of treatment to IFI or off study date
Time to Death From Any Cause
Time to death from any cause will be measured.
Number of Participants With Death Related to Invasive Fungal Infections (IFIs)
Death's from invasive fungal infections
Time to Diagnosis of Proven or Probable Invasive Fungal Infections (IFIs)
Time measured in days from start of treatment to invasive fungal infections
Time to Initiation of Empiric Anti-fungal Therapy
Time days from start of empiric anti-fungal therapy.

Full Information

First Posted
January 11, 2017
Last Updated
October 6, 2021
Sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT03019939
Brief Title
Isavuconazole in Preventing Invasive Fungal Infections in Adult Patients With Newly Diagnosed Acute Myeloid Leukemia or Myelodysplastic Syndrome and Neutropenia
Official Title
A Phase II Study of Isavuconazole Prophylaxis in Adult Patients With AML/MDS and Neutropenia
Study Type
Interventional

2. Study Status

Record Verification Date
October 2021
Overall Recruitment Status
Completed
Study Start Date
March 28, 2017 (Actual)
Primary Completion Date
August 10, 2020 (Actual)
Study Completion Date
August 10, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This phase II trial studies how well isavuconazole works in preventing invasive fungal infections in adult patients with newly diagnosed acute myeloid leukemia or myelodysplastic syndrome and neutropenia. Isavuconazole may help to prevent invasive fungal infections in adult patients with newly diagnosed acute myeloid leukemia or myelodysplastic syndrome and neutropenia.
Detailed Description
PRIMARY OBJECTIVES: I. To assess whether prophylaxis with isavuconazole effectively prevents the occurrence of proven or probable invasive fungal infections (IFIs) in patients with newly diagnosed acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) receiving successive cycles of intensive chemotherapy or other therapies for up to 100 days from prophylaxis initiation. SECONDARY OBJECTIVES: I. To evaluate the incidence of invasive aspergillosis (IA) within 100 days of beginning isavuconazole prophylaxis in newly diagnosed patients with AML/MDS receiving intensive chemotherapy or other therapies. II. To evaluate the incidence of other IFIs within 100 days of beginning isavuconazole prophylaxis in newly diagnosed patients with AML/MDS receiving intensive chemotherapy or other therapies. III. To evaluate the composite outcome of treatment success versus (vs.) failure in this patient population. IV. To measure the overall survival (OS) of study participants. V. To measure the IFI-free survival of study participants. VI. To document the time to death from any cause in the study population. VII. To document the time to death related to IFI in the study population. VIII. To document the time to diagnosis of proven or probable IFI in the study population. IX. To document the time to initiation of empiric anti-fungal therapy in the study population. X. To characterize the safety, tolerability and adverse event (AE) profile of isavuconazole in the prophylactic setting. EXPLORATORY OBJECTIVES: I. To assess the potential role, if any, of therapeutic drug monitoring (TDM) of isavuconazole levels in the prophylactic setting in patients with newly diagnosed AML/MDS receiving cytotoxic chemotherapy or other therapies. II. To determine the in vitro susceptibility of agents causing "breakthrough" IFIs to antifungal agents. OUTLINE: Patients receive isavuconazole orally (PO) every 8 hours for 6 doses and then once daily (QD) or intravenously (IV) over 1 hour every 8 hours for 6 doses and then QD for up to 4 days for 12 weeks in the absence of disease progression or unacceptable toxicity.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia, Myelodysplastic Syndrome, Neutropenia

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
65 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Prevention (isavuconazole)
Arm Type
Experimental
Arm Description
Patients receive isavuconazole PO every 8 hours for 6 doses and then Once a day (QD) or IV over 1 hour every 8 hours for 6 doses and then QD for up to 4 days for 12 weeks in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
Isavuconazole
Other Intervention Name(s)
BAL8557
Intervention Description
Given PO or IV
Primary Outcome Measure Information:
Title
Number of Participants With Proven or Probable Invasive Fungal Infections (IFIs)
Description
Participants with proven or possible invasive fungal infections.
Time Frame
Up to 100 days from prophylaxis initiation
Secondary Outcome Measure Information:
Title
Number of Participants With Invasive Aspergillosis
Description
Participants with invasive aspergillosissured.
Time Frame
Up to 100 days from prophylaxis initiation
Title
Number of Participants With Other Invasive Fungal Infections (IFIs)
Description
Participants with other IFIs will be measured.
Time Frame
Up to 100 days from prophylaxis initiation
Title
Number of Participants With Treatment Success
Description
Will evaluate versus (vs.) failure (defined as Participants with proven or probable IFI, receipt of any other systemic antifungal agent for +/- 4 days for suspected IFI, occurrence of an adverse events possibly or probably related to the study drug resulting in discontinuation of treatment, or withdrawal from the study with no additional follow-up).
Time Frame
Up to 3 years
Title
Number of Participants Who Failed Treatment
Description
Will evaluate versus success. Success is defined as Participants with proven or probable IFI, receipt of any other systemic antifungal agent for +/- 4 days for suspected IFI, occurrence of an adverse events possibly or probably related to the study drug resulting in discontinuation of treatment, or withdrawal from the study with no additional follow-up).
Time Frame
Up to 3 years
Title
Overall Survival (OS)
Description
Time from date of treatment start until date of death due to any cause or last Follow-up.
Time Frame
Up to 3 years
Title
Invasive Fungal Infections (IFIs)-Free Survival
Description
Time measured in days from start of treatment to IFI or off study date
Time Frame
Up to 3 years
Title
Time to Death From Any Cause
Description
Time to death from any cause will be measured.
Time Frame
Up to 3 years
Title
Number of Participants With Death Related to Invasive Fungal Infections (IFIs)
Description
Death's from invasive fungal infections
Time Frame
Up to 3 years
Title
Time to Diagnosis of Proven or Probable Invasive Fungal Infections (IFIs)
Description
Time measured in days from start of treatment to invasive fungal infections
Time Frame
Up to 3 years
Title
Time to Initiation of Empiric Anti-fungal Therapy
Description
Time days from start of empiric anti-fungal therapy.
Time Frame
Up to 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with either newly diagnosed AML or MDS who have either begun (within 4 days of starting study drug) or are planned to begin specific treatment for their AML/MDS; hydroxyurea and cytarabine used for cytoreduction while awaiting initiation of definitive therapy are not considered "specific" treatment; patients who are participating in other therapeutic clinical trials for their AML/MDS may participate in this trial Patients must have or be anticipated to have neutropenia (absolute neutrophil count [ANC] < 0.5 x 10^9/L) (75) for >= 7 days as a result of treatment of their AML/MDS Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2 Total bilirubin =< 3 x upper limit of normal (ULN) Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 5 x ULN Patients must be able to take oral medications, although a brief period of IV therapy (< 4 days) is permitted at trial entry Patients must be willing and able to provide written informed consent for the trial Women of childbearing potential (WOCBP) must practice 2 effective methods of birth control during the course of the study; male patients who are partners of WOCBP should also practice an effective method of contraception; effective methods of birth control include diaphragm or condoms with spermicidal foam or jelly, birth control pills (BCPs), injections or patches, intra-uterine devices (IUDs) and surgical sterilization Postmenopausal women must be amenorrheic for >= 12 months to be considered of non-childbearing potential Women and men must continue birth control for the duration of the trial and >= 3 months after the last dose of study drug All WOCBP MUST have a negative pregnancy test prior to first receiving study medication Exclusion Criteria: Proven, probable or possible IFI within the previous 30 days Use of any systemic antifungal therapy for > 72 hours during the week prior to study drug initiation History of hypersensitivity or idiosyncratic reactions to azoles Patients with familial short QT syndrome or with corrected QT (QTc) interval =< 300 ms Patients on strong CYP3A4 inducers or inhibitors that cannot be discontinued Women who are pregnant or nursing, or intend to be/do so during the course of the study Patients with severe hepatic impairment (Child-Pugh class C) Patients with known or suspected Gilbert's syndrome at the time of study enrollment Patients with known gastrointestinal conditions that could potentially interfere with absorption of orally administered medications Any condition that, in the opinion of the investigator, may interfere with the objectives of the study, e.g., any condition requiring the use of prohibited drugs or unstable medical conditions other than AML/MDS, such as a cardiac or neurologic disorder expected to be unstable or progressive during the course of the study (e.g., seizures or demyelinating syndromes, acute myocardial infarction within 3 months of study entry, myocardial ischemia or unstable congestive heart failure, unstable arrhythmias)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Prithviraj Bose
Organizational Affiliation
M.D. Anderson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
M D Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
32236406
Citation
Bose P, McCue D, Wurster S, Wiederhold NP, Konopleva M, Kadia TM, Borthakur G, Ravandi F, Masarova L, Takahashi K, Estrov Z, Yilmaz M, Daver N, Pemmaraju N, Naqvi K, Rausch CR, Marx KR, Qiao W, Huang X, Bivins CA, Pierce SA, Kantarjian HM, Kontoyiannis DP. Isavuconazole as Primary Antifungal Prophylaxis in Patients With Acute Myeloid Leukemia or Myelodysplastic Syndrome: An Open-label, Prospective, Phase 2 Study. Clin Infect Dis. 2021 May 18;72(10):1755-1763. doi: 10.1093/cid/ciaa358.
Results Reference
derived
Links:
URL
http://www.mdanderson.org
Description
University of Texas MD Anderson Cancer Center Website

Learn more about this trial

Isavuconazole in Preventing Invasive Fungal Infections in Adult Patients With Newly Diagnosed Acute Myeloid Leukemia or Myelodysplastic Syndrome and Neutropenia

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