Prevention and Treatment of Invasive Fungal Infections in Patients with Cancer: The Emerging Roles of New Triazoles and Echinocandins

THOMAS J. WALSH

Author address: 

Natl. Cancer Inst., Bethesda, MD

Abstract: 

Invasive fungal infections have emerged as important causes of morbidity and mortality in immunocompromised patients with cancer, particularly those persistent neutropenia, BMT, or other severe immunodeficiency. Once developed, these infections may carry an ominous prognosis. The introduction of second generation triazoles and echinocandins provides new opportunities for therapeutic intervention and prevention of these infections. The second-generation triazoles include voriconazole, posaconazole, and ravuconazole. These compounds, which were developed through in vitro screening against Aspergillus spp., have low MICs, a broad antifungal spectrum against yeasts, and filamentous fungi beyond Aspergillus spp., parenteral and oral formulations, a favorable safety profile, and plasma half-life permitting once or twice daily dosing. The echinocandins are cyclic hexapeptides with modified N-acyl side chains that permit expanded antifungal spectrum, which includes Candida spp., Aseprgillus spp., Pneumocystis carinii, but not Cryptococcus neoformans. As relatively large molecules, the echinocandins have minimal oral bioavailability and are provided only as parenteral solutions. The recent results of clinical trials with these compounds indicate that they will likely change the patterns of future practice in the treatment and prevention of infections in patients with cancer.
2002

abstract No: 

1016

Full conference title: 

42nd ICAAC Abstracts, American Society for Microbiology, September 27 - 30, 2002, San Diego, CA
    • ICAAC 42nd