Multicenter Noncomparative Study of Caspofungin (CAS) Combined with Other Antifungals in Adults with Invasive Aspergillosis (IA) Refractory (R) or Intolerant (I) to Standard Regimens

J. MAERTENS1, A. GLASMACHER 2, R. HERBRECHT 3, C. CORDONNIER 4, B. SEGAL 5, M. AOUN 6, D. CAILLOT 7, C. SABLE 8, D. RYAN 8, A. TAYLOR 8, N. KARTSONIS 8, T. PATTERSON 9

Author address: 

1UZ Gasthuisberg, Leuven, Belgium, 2U Bonn, Bonn, Germany, 3U Strasbourg, Strasbourg, France, 4CHU Henri Mondor, Creteil, France, 5Roswell Park Cancer Inst, Buffalo, NY, 6U Libre Bruxelles, Bruxelles, Belgium, 7U Burgandy, Dijon, France, 8Merck Res L

Abstract: 

Background: CAS was 44% successful as salvage monotherapy (Rx) of IA. We studied if CAS combined (comb) with poylenes/triazoles can improve efficacy. Data on first 30 patients (pts) enrolled in a comb study of CAS & other antifungals as salvage Rx are available. Methods: Adults with proven/probable IA (per EORTC/MSG criteria), R or I to standard Rx, received CAS 70 mg/d & >1 other antifungal. Efficacy was based on signs, symptoms & radiographs. Favorable responses (complete/partial) required significant overall improvement. Diagnoses & outcomes were assessed by an independent expert. Results: 30 pts with IA had >1d of comb Rx. Underlying diseases were AML (47%), ALL (10%), CLL/lymphoma (17%), & other hematological conditions (17%). Allo (20%) & auto (10%) HSCT & neutropenia (57%) were common. Sites were lung (80%), disseminated (17%) & sinus (3%). 24 (80%) were R & 6 (20%) were I of prior Rx. Success at end of comb Rx (EOCT) was 57%.[Table1] Success in pts with >7d of comb Rx was 70% (16/23). 47% (8/17) with neutropenia & 56% (5/9) with HSCT (3/6 allo, 2/3 auto) responded. Comb Rx for 1-71 (mean 25) d was well tolerated. 1 (3%) serious drug-related (DR) AE (hypernatremia) was noted. No pt discontinued CAS due to DRAE. Conclusion: These data suggest promise for comb Rx with CAS as salvage Rx of IA.
2004

abstract No: 

M-671a-200

Full conference title: 

44th Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 44th