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Empirical Versus Preemptive Antifungal Therapy

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ClinicalTrials.gov Identifier: NCT01288378
Recruitment Status : Completed
First Posted : February 2, 2011
Last Update Posted : August 8, 2019
Sponsor:
Information provided by (Responsible Party):
European Organisation for Research and Treatment of Cancer - EORTC

Brief Summary:

RATIONALE: Caspofungin acetate may be effective in treating fungal infections in patients with acute myeloid leukemia or myelodysplastic syndrome who are receiving treatment for their cancer. It is not yet known whether caspofungin acetate is more effective when treatment starts after development of a fever or after the infection is shown in laboratory test, chest x-ray, or CT scan.

PURPOSE: This randomized phase III trial is studying the best time to start caspofungin acetate therapy in treating patients with acute myeloid leukemia or myelodysplastic syndrome that is newly diagnosed or in first relapse.


Condition or disease Intervention/treatment Phase
Fungal Infection Leukemia Myelodysplastic Syndromes Drug: caspofungin acetate Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 556 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Empirical Versus Pre-emptive (Diagnostic-driven) Antifungal Therapy of Patients Treated for Haematological Malignancies or Receiving an Allogeneic Stem Cell Transplant. A Therapeutic Open Label Phase III Strategy Study of the EORTC Infectious Diseases and Leukemia Groups
Study Start Date : March 2012
Actual Primary Completion Date : April 4, 2019
Actual Study Completion Date : April 4, 2019


Arm Intervention/treatment
Active Comparator: Empirical
Empirical approach (fever driven) for starting antifungal therapy
Drug: caspofungin acetate
intravenous route, at a 70 mg loading dose on day 1 of antifungal therapy, followed by 50 mg once a day thereafter.

Experimental: Pre-emptive
Pre-emptive approach (diagnostic driven) for starting antifungal therapy
Drug: caspofungin acetate
intravenous route, at a 70 mg loading dose on day 1 of antifungal therapy, followed by 50 mg once a day thereafter.




Primary Outcome Measures :
  1. Overall survival at 42 days after randomization [ Time Frame: 6 weeks after randomization ]

Secondary Outcome Measures :
  1. Overall survival at 84 days after randomization [ Time Frame: 12 weeks after randomization ]
  2. Development of proven or probable invasive fungal disease (IFD) during the 42 and 84 days following randomization [ Time Frame: during 84 days after randomization ]
  3. Proper management according to allocated treatment arm (i.e., appropriate administration of caspofungin acetate in compliance to protocol, and compliance to the treatment strategy) during the 42 and 84 days after randomization [ Time Frame: during 84 days after randomization ]
  4. Survival-free of fungal infection during the 42 and 84 days following randomization [ Time Frame: during 84 days after randomization ]
  5. Safety (adverse event [AE] and serious adverse event [SAE]) as assessed by CTCAE criteria v4.0 [ Time Frame: during 84 days after randomization ]
  6. Number of days under caspofungin treatment or under another antifungal treatment administered after caspofungin (evaluation will be done at day 42 and day 84 after randomization) [ Time Frame: at day 42 and day 84 after randomization ]
  7. Costs related to the strategy for initiating and monitoring antifungal treatment during the 42 and 84 days following randomization [ Time Frame: during 84 days after randomization ]


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS)

    • Newly diagnosed disease or disease in first relapse after hematological remission lasting for a minimum of 6 months AND meets one of the following criteria:

      • Starting remission-induction chemotherapy within 3 days prior to study randomization
      • Starting myeloablative conditioning regimen to prepare for a first allogeneic hematopoietic stem cell transplantation within 3 days prior to study randomization
  • Planning a hospital admission for the duration of the neutropenic phase (ANC < 0.5 x 10^9 /L)
  • Planning to receive oral or intravenous fluconazole for Candida prophylaxis at a dose of 400 mg/day

    • Fluconazole is discontinued during caspofungin acetate administration
  • No previous or current history of proven or probable invasive fungal disease (IFD)

PATIENT CHARACTERISTICS:

  • See Disease Characteristics
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients muse use effective contraception during and for at least 3 months after completion of study therapy
  • No current clinical diagnosis of pneumonia
  • No serious, uncontrolled, concomitant disease or comorbidity that, in the opinion of the investigator, may compromise adherence to the study protocol
  • No history of allergy or any adverse reaction to echinocandin drugs (i.e., caspofungin acetate, micafungin, or anidulafungin)
  • No hypersensitivity to caspofungin active substance or to any of the excipients
  • No inadequately treated infection
  • No documented HIV infection
  • No psychological, familial, sociological, or geographical condition potentially hampering compliance with the study protocol and follow-up schedule
  • No history of liver cirrhosis or severe hepatic insufficiency (i.e., Child Pugh Class C, D, or E)

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No concurrent participation on another clinical trial using an investigational drug for infectious diseases
  • No other concurrent systemic antifungal therapy (oral or intravenous)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01288378


Locations
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Belgium
A.Z. St. Jan
Brugge, Belgium
Cliniques Universitaires Saint-Luc
Brussels, Belgium
Hôpitaux Universitaires Bordet-Erasme - Institut Jules Bordet
Brussels, Belgium
U.Z. Gasthuisberg
Leuven, Belgium
C.H.U. Sart-Tilman
Liège, Belgium
Czechia
Masaryk University
Brno, Czechia
France
CHU de Caen - Hopital Cote de Nacre
Caen, France
C.H.U. Henri Mondor AP-HP
Créteil, France
CHRU de Lille - Hopital Hurie
Lille, France
CHU de Limoges - Hopital Dupuytren
Limoges, France
Hopital Universitaire Hautepierre
Strasbourg, France
Institut Gustave Roussy
Villejuif, France
Germany
Universitaetsklinikum Freiburg
Freiburg, Germany
Universitaetsklinikum Wuerzburg - Medizinische Klinik und Poliklinik II
Wuerzburg, Germany
Netherlands
Radboud University Nijmegen Medical Centre
Nijmegen, Netherlands
Slovakia
National Cancer Institute
Bratislava, Slovakia
Sponsors and Collaborators
European Organisation for Research and Treatment of Cancer - EORTC
Investigators
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Study Chair: J. Peter Donnelly Universitair Medisch Centrum St. Radboud - Nijmegen
Study Chair: Johan Maertens, MD University Hospital, Gasthuisberg
Study Chair: Catherine Cordonnier, MD, PhD Centre Hospitalier Universitaire Henri Mondor
Study Chair: Tom Lodewyck AZ Sint-Jan
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Responsible Party: European Organisation for Research and Treatment of Cancer - EORTC
ClinicalTrials.gov Identifier: NCT01288378    
Other Study ID Numbers: EORTC-65091-06093
2010-020814-27 ( EudraCT Number )
MK-0991-070 ( Other Identifier: Merck (MSD) )
First Posted: February 2, 2011    Key Record Dates
Last Update Posted: August 8, 2019
Last Verified: August 2019
Keywords provided by European Organisation for Research and Treatment of Cancer - EORTC:
fungal infection
de novo myelodysplastic syndromes
previously treated myelodysplastic syndromes
secondary myelodysplastic syndromes
recurrent adult acute myeloid leukemia
untreated adult acute myeloid leukemia
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute myeloid leukemia with del(5q)
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with t(15;17)(q22;q12)
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with t(8;21)(q22;q22)
secondary acute myeloid leukemia
Additional relevant MeSH terms:
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Mycoses
Leukemia
Preleukemia
Myelodysplastic Syndromes
Syndrome
Disease
Pathologic Processes
Neoplasms by Histologic Type
Neoplasms
Infections
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Bacterial Infections and Mycoses
Caspofungin
Antifungal Agents
Anti-Infective Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action