Intermittent Liposomal Amphotericin B Primary Prophylaxis

Condition(s) targeted: Acute Myeloid Leukemia

Intervention: Liposomal amphotericin B (Drug)

Phase: Phase 2

Status: Not yet recruiting

Sponsored by: Bayside Health

Official(s) and/or principal investigator(s):
C. Orla Morrissey, MB, BCh, FRACP, Principal Investigator, Affiliation: The Alfred Hospital, Level 2 Burnet Institute, Commercial Rd., Melbourne, 3004, Victoria, Australia
Anthony P Schwarer, MB, BS, FRACP, MD, FRCPA, Principal Investigator, Affiliation: The Alfred Hospital, Ground Floor South Block, Commercial Rd., Melbourne, Victoria, 3004, Australia

Overall contact:
C. Orla Morrissey, MB, BCh, FRACP, Phone: +61 3 9076 2000, Ext: 62631, Email: o.morrissey@alfred.org.au

The purpose of this trial is to see which dose of liposomal amphotericin B is the safest when used as a preventer against invasive fungal infection in patients with acute leukaemia who are undergoing chemotherapy.

Official title: A Randomised, Stratified, Open Label, Phase II Pilot Study on the Safety of a Daily, Intermittent, or Weekly Administration of 1, 3 or 10mg/kg of AmBisome® in Antifungal Primary Prophylaxis of High-Risk Patients With Acute Myeloid Leukaemia

Study design: Prevention, Randomized, Open Label, Dose Comparison, Parallel Assignment, Safety Study

Primary outcome: Safety as defined by the incidence of all adverse events occurring by the completion of each trial prophylaxis course.

Secondary outcome:

Safety:

Incidence of renal toxicity

Incidence of hepatotoxicity

Incidence of ionic abnormalitities

Incidence of cardiovascular toxicity

Efficacy:

Incidence of proven or probable IFI

Incidence of superficial fungal infections

Incidence of fever of unknown origin requiring empirical antifungal therapy during any course of prophylaxis

Incidence of IFI-related mortality

Detailed description: Invasive Fungal Infections (IFI)are a significant cause of death in patients with acute leukaemia who are undergoing chemotherapy. This is despite improvements in antifungal therapy for the treatment of IFI. The major reason for this is that the current standard diagnostic tests of culture and biopsy lack the ability to make a diagnosis, either early or accurately. Thus other strategies such as the use of prophylaxis are needed. Several antifungal agents have been trialled as prophylaxis but all have disadvantages that limit their effectiveness.

Liposomal amphotericin B(LAB) is a broad spectrum antifungal agent that kills fungal cells. When given in high doses intermittently it supersaturates the liver and the overspill into the bloodstream is absorbed by tissues such as lung, brain and kidneys (i. e. sites where IFI are likely to occur). This effect has been shown in a number of animal and laboratory test-tube studies to reduce fungal burden, improve survival and maintain adequate levels of the drug in between doses. However no intermittent high-dose prophylaxis study has been done in humans. Thus before we proceed to a randomised controlled clinical trial of the efficacy of intermittent high-dose LAB compared with another antifungal agent it is necessary to determine in a phase 2 study which of 2 intermittent dosing LAB regimens (i. e. 3mg/kg three times a week or 10mg/kg once a week) administered during the neutropenic phase of induction-consolidation chemotherapy for treatment of acute leukaemia is safest and best tolerated compared to the standard dosing regimen of 1mg/kg daily of LAB.

Males and females aged >18 years who are undergoing intensive combination chemotherapy for acute leukaemia will be randomised 1: 1:1 to either 1mg/kg daily; 3mg/kg 3 times a week or 10mg/kg once weekly of intravenous liposomal amphotericin B. The 3 arms will be compared for the safety of the 3 dosing regimens.

Minimum age: 18 Years. Maximum age: 80 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

Patients fulfilling all the following criteria will be eligible:

- Male or female aged >18years;

- Newly diagnosed with acute myeloid leukaemia and undergoing first induction

chemotherapy regimen;

- Expected to have absolute neutrophil counts of <0. 5x109/L for at least 2 weeks;

- Normal high resolution chest and sinus CT scan at baseline;

- No signs or symptoms of invasive fungal infections

- No prior diagnosis of proven or probable invasive fungal infection within the last 6

months;

- Females of childbearing potential must be: surgically incapable of pregnancy; or

practicing an acceptable mode of birth control and have a negative pregnancy test (blood or urine) at baseline;

- Give written informed consent prior to any study-specific procedures;

- Must have the ability and must agree to comply with all study requirements.

Exclusion Criteria:

Patients with any of the following will be ineligible

- Known hypersensitivity to amphotericin B, in particular known history of anaphylactic

reaction to amphotericin B;

- Patients undergoing any transplantation;

- Creatinine clearance <60mL/min/1. 72 m2;

- Patients with moderate or severe liver disease as defined by aspartate

aminotransferase (AST) or alanine aminotransferase (ALT) > 5 times the upper limit of normal (ULN)

- Patients who are unlikely to survive more than one month;

- Patients who have received systemic antifungal therapy within the last 15 days

- Any severe cardiovascular disease ( in particular arrhythmias) which may constitute a

contra-indication to LAB (AmBisome®) administration;

- Any severe diseases other than acute myeloid leukaemia which in the investigator’s

judgement may interfere with study evaluations or affect the patients safety;

- Pregnant or nursing females;

- Patients previously included in this study;

- Patients who have taken an investigational drug in the last 30 days prior to the

inclusion.

- Patients enrolled in a pre-emptive treatment strategy trial

C. Orla Morrissey, MB, BCh, FRACP, Phone: +61 3 9076 2000, Ext: 62631, Email: o.morrissey@alfred.org.au

The Alfred Hosptial, Melbourne, Victoria 3004, Australia

Box Hill Hospital, Eastern Health, Melbourne, Victoria 3129, Australia

Starting date: May 2007
Ending date: October 2009
Last updated: March 21, 2007