title: Switching to anidulafungin from caspofungin in cancer patients in the setting of liver dysfunction is associated with improvement of liver function tests.
abstract: BACKGROUND
  Anidulafungin does not undergo hepatic metabolism like the other echinocandins. Therefore, there is a perception that anidulafungin may be less hepatotoxic or less likely to exacerbate existing liver damage. This has not been substantiated in the literature.
  
  
  METHODS
  We retrospectively reviewed all cancer patients in whom anidulafungin treatment was immediately preceded by treatment with caspofungin and there existed clinical or laboratory evidence of hepatic damage or dysfunction at M. D. Anderson Cancer Center from January 2010 to December 2013.
  
  
  RESULTS
  Sixty-one patients were included in the study. Most patients had haematological malignancies (58, 95%), and the patients were administered hepatotoxic agents such as chemotherapeutic agents (47, 77%) and other medications (38, 62%) simultaneously. There were significant decreases in AST and ALT (P < 0.029 and P < 0.0017, respectively) between two timepoints (switch from caspofungin to anidulafungin and end of anidulafungin therapy). The median changes in AST, ALT and total bilirubin during anidulafungin therapy were -43 IU/L, -25 IU/L and -0.15 mg/dL, respectively. Over 70% of patients had favourable changes in hepatic enzymes or function, and values were stable and decreased at the end of anidulafungin therapy. On average, the percentage of patients with laboratory results meeting common terminology criteria for adverse events (CTCAE) grade ≥2 at the time of switching to anidulafungin was decreased at the end of treatment.
  
  
  CONCLUSIONS
  Median serum values and trajectory of hepatic enzymes and hepatotoxicity usually decreased after switching to anidulafungin treatment in patients with abnormal liver function tests. Anidulafungin could be useful in the management of cancer patients with hepatotoxicity occurring during caspofungin therapy.
authors: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA Division of Infectious Diseases, Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea.
authors: Dong Sik
authors: DS
authors: Jung
authors: Pharmacy Clinical Programs, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Frank P
authors: FP
authors: Tverdek
authors: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Ying
authors: Y
authors: Jiang
authors: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA dkontoyi@mdanderson.org.
authors: Dimitrios P
authors: DP
authors: Kontoyiannis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077612:Anidulafungin; D000077336:Caspofungin; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology*; D064420:Drug-Related Side Effects and Adverse Reactions; D054714:Echinocandins / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D055666:Lipopeptides; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000517:prevention & control*; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D054714:Echinocandins; D055666:Lipopeptides; D000077612:Anidulafungin; D000077336:Caspofungin