The Combination of Caspofungin (C) and Voriconazole (V) as Primary and Salvage Therapy of Invasive Aspergillosis (IA) in Hematologic Malignancy Patients (HMP).


Author address: 

U. T. M. D. Anderson Cancer Ctr., Houston, TX.


Background: IA in HMP is associated with high mortality when treated with antifungal monotherapy. Recent reports have suggested that the combination of V+C could improve outcome in transplant patients(pts). We determined to study the efficacy and safety of V, C and the combination as primary and salvage therapy of HMP. Methods: Between June 1993 and October 2005 a total of 383 HMP were diagnosed with IA (according to EORTC/MSG criteria). There were 21 pts who received V alone as primary antifungal therapy, 20 pts received C alone, and 24 pts received V+C. In addition, there were 19 pts who received V alone as salvage therapy, 17 pts who received C alone, and 33 pts who received V+C. Clinical characteristics as well as response to salvage therapy and safety data were retrospectively obtained on all patients. Results: The three primary groups were comparable in terms of pulmonary involvement, dissemination, age, gender, neutropenia at onset, duration and persistence of neutropenia, steroid use, duration of ICU stay, and mechanical ventilation, and type of Aspergillus spp. (fumigatus vs. non-fumigatus). However, the response to V+C primary therapy was 50% compared to 30% for C and 19% for V, respectively (P 8804; 0.03). For salvage therapy, these three groups also had comparable clinical characteristics. However, mortality for C at six weeks, 12 weeks and six months after initiating salvage therapy was 53%, 71% and 82%, respectively, compared to 24%, 39% and 52% for V+C (P 8804; 0.04). Furthermore, the mean days (±SD) from initiating salvage therapy to death was 19.5 ± 10.7 for V compared to 58.2 ± 50.9 for V+C (P = 0.07). All three groups had comparable safety, including drug-related hepatotoxicities. Conclusions: The combination of V+C was associated with an improved response to either drug used alone as primary therapy of IA in HMP and when used as salvage V+C may be associated with improved survival, particularly when compared to C alone.

abstract No: 


Full conference title: 

46th Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 46th