High-Dose Caspofungin (HD-CAP) in Cancer Patients with Invasive Fungal Infections (IFIs).

A. SAFDAR1, G. H. RODRIGUEZ 1, E. J. SHPALL 1, T. J. WALSH 2, D. P. KONTOYIANNIS 1, R. E. CHAMPLIN 1, H. M. KANTARJIAN 1, K. V. ROLSTON 1, I. I. RAAD 1;

Author address: 

1M.D. Anderson Cancer Ctr., Houston, TX, 2Natl. Cancer Inst., Bethesda, MD.

Abstract: 

Background: We have recently reported safety of HD-CAP (100 mg daily) therapy in 34 cancer patients. In this study, we report feasibility of HD-CAP in additional 70 patients. Methods: Patients who received HD-CAP (2002-2005) at MDACC were evaluated under an existing IRB protocol. Safety was determined in patients who have received > 3 doses and for efficacy > 7 doses of HD-CAP. EORTC/MSG criteria were used to define IFIs. Outcomes were evaluated at the end of therapy. Response was defined as complete or partial response (CR, PR), or stable disease (SD). Results: In 70 patients HD-CAP was associated with no drug-related serious adverse events. The median change in values between start and end of > 4 weeks of HD-CAP therapy (n=11) were as follows: creatinine 0.2 ± 0.3 mg/dL; total bilirubin 0.5 ± 1.8 mg/dL; ALT 38 ± 29 IU/L; and alkaline phosphatase 26 ± 39 IU/L (p > 0.3). In 47 patients treatment response was evaluated, the age was 48 ± 14 years. In 68% cancer was refractory. Leukemia was common (66%). In 14 (30%) allogeneic stem cell transplant recipients, 7 patients had GvHD. APACHE II score was 14 ± 4. During antifungal therapy, 53% of patients remained neutropenic (7 ± 15 days) and in 36% high-dose corticosteroids were continued. Eighteen patients (38%) had proven IFI including 12 with aspergillosis and 3 with zygomycosis. One patient had probabale hepatosplenic candidiasis. Most patients (78%) received HD-CAP after failure to primary antifungal therapy. HD-CAP was given in combination with voriconazole or posaconazole in 21 patients (45%); a single patient received HD-CAP alone. Response occured in 28 patients (60%) including 16 patients (34%) with CR, 10 with PR (21%) and SD in 2 patients (4%). Deaths attributed to progressive IFI were observed in 9 patients (19%). Conclusions: HD-CAP salvage therapy was well tolerated and appears to provide an alternative in cancer patients who fail primary antifungal therapy.
2007

abstract No: 

M-1169

Full conference title: 

47th Interscience Conference on Antimicrobial agents and Chemotherapy
    • ICAAC 47th