Antifungal management in cancer patients.
Invasive fungal infections (IFI) are a major cause of morbidity and mortality in cancer patients receiving myelotoxic chemotherapy. Established risk factors are previous fungal infection, neutropenia exceeding 10 days, older age, active cancer, corticosteroid therapy, administration of broad spectrum antibiotics, allogeneic HSCT, central venous catheter and organ dysfunction. The strategies to manage IFI comprise chemoprophylaxis, preemptive, empirical and directed antifungal therapy. Benefit of antifungal prophylaxis has been proven for fluconazole (400 mg/d) in allogeneic transplant recipients, and for posaconazole (600 mg/d) in patients during AML/MDS induction chemotherapy as well as in patients with GvHD. Pre-emptive therapy based on sensitive diagnostic non-culture methods needs further validation in larger randomized studies before becoming a standard. Empirical antifungal therapy is well established and should consist of either liposomal amphotericin B, itraconazole, voriconazole, or caspofungin. In patients with documented invasive aspergillosis, therapy with voriconazole is the treatment of choice. Liposomal amphotericin B is a good alternative candidate and caspofungin is reserved for salvage treatment. Invasive candidiasis should be treated with caspofungin or one of the lipid based amphotericin B formulations. Since non-albicans species are increasingly observed, the use of fluconazole is reserved for "stable", non-neutropenic patients.
Staber
Philipp
P
Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Langner
Stefan
S
Dornbusch
Hans Jürgen
HJ
Neumeister
Peter
P
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D016026:Bone Marrow Transplantation; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D002423:Cause of Death; D002648:Child; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D009369:Neoplasms / Q000382:microbiology* / Q000401:mortality; D009894:Opportunistic Infections / Q000188:drug therapy* / Q000401:mortality; D011292:Premedication; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015996:Survival Rate
D000935:Antifungal Agents