The Deferasirox-AmBisome Therapy for Mucormycosis (DEFEAT Mucor) Study

Condition(s) targeted: Mucormycosis

Intervention: deferasirox (Drug)

Phase: Phase 2

Status: Recruiting

Sponsored by: Los Angeles Biomedical Research Institute

Official(s) and/or principal investigator(s):
Brad Spellberg, MD, Principal Investigator, Affiliation: Los Angeles Biomedical Research Institute

Overall contact:
Brad Spellberg, MD, Phone: 310-222-5381, Email: bspellberg@labiomed.org

The purpose of this study is to determine if the addition of the medication, deferasirox, to standard antifungal therapy for the infection, mucormycosis, is safe and effective

Official title: The Deferasirox-AmBisome Therapy for Mucormycosis (DEFEAT Mucor) Study

Study design: Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Placebo Control, Parallel Assignment, Safety/Efficacy Study

Primary outcome:

Safety and tolerability of adjunctive deferasirox therapy in patients being treated with LAmB for mucormycosis

Global response rate (composite of clinical and radiographic response) at end of study drug administration, as determined by a blinded adjudication committee

Secondary outcome:

Deferasirox pharmacokinetic and pharmacodynamic parameters

Survival, radiographic improvement, clinical response, time to survival, deferasirox vs. free iron level correlation

Detailed description: Because of its extremely high morbidity and mortality, it is imperative to look for new antifungal therapies to treat mucormycosis. The agents of mucormycosis are exquisitely sensitive to iron availability, and we and others have demonstrated that iron chelation therapy improves the survival of rodents with mucormycosis. Deferasirox (Exjade) is the first orally bioavailable iron chelator approved for use in the United States (US) by the Food and Drug Administration (FDA), with an indication for treatment of iron overload from chronic transfusions. In clinical studies, deferasirox has been well tolerated and effective in iron-overloaded patients.

Although the safety and efficacy of deferasirox have been extensively evaluated in iron-overloaded patients, there are minimal data in non-iron-overloaded patients or in infected patients. Therefore, the safety and efficacy of deferasirox in patients with mucormycosis is unclear, and confirming safety in the current study, at the currently planned dose, is required to lay the groundwork for a future phase III clinical trial.

This is a prospective, phase II, randomized, double-blinded, placebo-controlled study of liposomal amphotericin B (LAmB; AmBisome) plus deferasirox vs. LAmB plus placebo for mucormycosis infection. Twenty patients with proven or probable mucormycosis (except for isolated skin infection) by consensus EORTC/MSG criteria, who have received less than 14 days of antifungal therapy for mucormycosis, and who have had radiographic imaging by CT or MRI within the past 72 hours that shows evidence of infection, will be randomized to receive LAmB plus deferasirox or placebo (n = 10 per arm), with randomization stratified by study site.

The primary objective is to determine the safety and tolerability of adjunctive deferasirox therapy in patients being treated with LAmB for mucormycosis, and to obtain exploratory data on the efficacy of the iron chelation treatment. The exploratory efficacy endpoint will be the global response rate (composite of clinical and radiographic response) at end of study drug administration, as determined by a blinded adjudication committee.

Minimum age: 2 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Age greater than 2 years.

- Proven or probable invasive mucormycosis, as defined by modification of consensus

European Organization for Research and Treatment of Cancer (EORTC)/Mycosis Study Group (MSG) criteria. In brief, proven mucormycosis is defined as: 1) histopathologic or cytopathologic examination showing broad-based, aseptate, ribbon-like hyphae consistent with Mucorales from needle aspiration or biopsy specimen, with evidence of associated tissue damage (either microscopically or unequivocally by imaging); OR 2) a positive culture result for a sample obtained by sterile procedure from normally sterile and clinically or radiologically abnormal site consistent with infection, excluding urine and mucous membranes. Probable mucormycosis is defined as: 1) an at-risk host; AND 2) positive culture, cytology, or polymerase chain reaction (PCR) test (run at a CLIA-certified clinical microbiology laboratory) from sputum, bronchoalveolar lavage (BAL), endoscopy/colonoscopy, or sinus aspirate/biopsy; AND 3) 1 major or 2 minor clinical criteria.

- Radiographic study by Computerized Tomography (CT) or Magnetic Resonance Imaging

(MRI) has been obtained within 4 calendar days prior to enrollment and shows evidence of infection (i. e. focal nodule, mass, or abscess, or enhancement, or evidence of tissue edema or destruction that is not attributed to post-surgical reaction).

- Subject or authorized decision maker able to provide informed consent.

Exclusion Criteria:

- High likelihood of death within the 48 h after enrollment (investigator's

discretion).

- High likelihood of death due to factors unrelated to mucormycosis (e. g. due to

uncontrolled and/or relapsed malignancy, severe graft versus host disease, other underlying diseases, etc.) within 30 days following enrollment (investigator's discretion).

- Patient unable to receive enteral medication (oral or via feeding tube).

- Infection limited to the supra-fascial skin (skin lesions in the presence of

disseminated disease, deep invasive tissue infection spreading from a primary skin site, or subcutaneous infections extending to fascia are allowed).

- Patient has received > 14 days of polyene antifungal therapy (i. e. amphotericin B

deoxycholate, liposomal amphotericin B, amphotericin B lipid complex, or amphotericin B colloidal dispersion) at the time of screening.

- Patient is already taking deferasirox therapy for any reason at the time of

screening.

- Patient is allergic to or intolerant of deferasirox or LAmB.

- Patient has significant renal dysfunction at the time of screening, defined as serum

creatinine of > 3 mg/dL or a calculated creatinine clearance of < 30 ml/min (by the

Cockroft-Gault formula: (140 - age (yrs) * wt (kg)) * 0. 85 (for females) / (72 *

serum creatinine (mg/dL)).

- Patient has significant hepatic dysfunction at the time of screening, defined as BOTH

an AST or ALT > 10 times the upper limit of normal, AND a direct (not total) bilirubin > 5 times the upper limit of normal.

- Women of child-bearing potential (those with menses within the last year) with a

positive serum pregnancy test.

- Enrollment refused by the primary physician.

Brad Spellberg, MD, Phone: 310-222-5381, Email: bspellberg@labiomed.org

UCSF, San Francisco, California 94143, United States; Recruiting
Peter Chin-Hong, MD, Principal Investigator

City of Hope National Medical Center, Duarte, California 91010, United States; Recruiting
Mary Ann Clouser, Phone: 626-256-4673, Ext: 62340, Email: MClouser@coh.org
James Ito, MD, Principal Investigator

University of Miami, Miami, Florida 33136, United States; Recruiting
Gabriel Blashke, Phone: 305-585-7624, Email: GBlaschke@med.miami.edu
Michele Morris, MD, Principal Investigator

Duke University, Durham, North Carolina 27710, United States; Recruiting
Elizabeth Dodds, PharmD, Email: dodds002@mc.duke.edu
John Perfect, MD, Principal Investigator

Summa Health Systems, Akron, Ohio 44304, United States; Recruiting
Sara-Jane Salstrom, Phone: 330-375-4293, Email: salstros@summa-health.org
Hector Bonilla, MD, Principal Investigator

MD Anderson Cancer Center, Houston, Texas 77030, United States; Recruiting
Stacie Wright, RN, Phone: 713-792-2095, Email: slwright@mdanderson.org
Dimitrios Kontoyiannis, MD, Principal Investigator

Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, United States; Recruiting
Judy Schramm, RN, Phone: 206-667-4872
David Fredericks, MD, Principal Investigator

Related publications:

Spellberg B, Edwards J Jr, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005 Jul;18(3):556-69. Review.

Ibrahim AS, Edwards JE Jr, Fu Y, Spellberg B. Deferiprone iron chelation as a novel therapy for experimental mucormycosis. J Antimicrob Chemother. 2006 Nov;58(5):1070-3. Epub 2006 Aug 23.

Reed C, Ibrahim A, Edwards JE Jr, Walot I, Spellberg B. Deferasirox, an iron-chelating agent, as salvage therapy for rhinocerebral mucormycosis. Antimicrob Agents Chemother. 2006 Nov;50(11):3968-9. Epub 2006 Sep 25. No abstract available.

Boelaert JR, Van Cutsem J, de Locht M, Schneider YJ, Crichton RR. Deferoxamine augments growth and pathogenicity of Rhizopus, while hydroxypyridinone chelators have no effect. Kidney Int. 1994 Mar;45(3):667-71.

Starting date: October 2007
Ending date: December 2009
Last updated: September 9, 2009