September 23, 2015
Fungal Infection Drug Increases Skin Cancer Risks in Lung Transplant Recipients

San Francisco—A prescription drug commonly used to treat fungal infections in lung transplant recipients appears to significantly increase the risk for skin cancer, according to a new study.

The report, which appears online in the American Journal of Transplantation, recommends that healthcare professionals be aware of patient-specific factors that could modify the risks and benefits of voriconazole.

“We recommend that all providers counsel lung transplant recipients on skin cancer risk and photo-protection in addition to scheduling routine skin cancer screening with a trained dermatologist after transplantation,” said senior author Sarah Arron, MD, PhD, associate professor of dermatology and director of the University of California San Francisco High Risk Skin Cancer Clinic. “Lung transplant programs should also consider patient-specific risk factors when deciding on the type, dose and duration of antifungal prophylaxis regimens.”

Because of immunosuppression, skin cancer is the most common malignancy following solid organ transplants, with recipients having a 65-fold increased risk of developing cutaneous squamous cell carcinoma (SCC) compared to the general population, according to background information in the article. Usually older and undergoing more intensive immunosuppression, lung transplant recipients have particular susceptibility to SCC, as well as high rates of fungal infections after transplant, the report notes.

Since its approval in 2002, voriconazole has been used to prevent and treat invasive fungal infections, such as those caused by the Aspergillus fungi, especially in patients with compromised immune systems. Yet, SCC is a serious side effect of voriconazole, which has no clear guidelines for prophylaxis regimens despite its widespread use.

For the study, the researchers evaluated 455 single-lung, double-lung, or heart-lung transplant recipients receiving a transplant at UCSF between October 1991 and December 2012, looking at voriconazole exposure and its impact on SCC, Aspergillus colonization, invasive aspergillosis and all-cause mortality.

The researchers found that voriconazole exposure resulted in a 73% greater risk for SCC, with each additional 30-day exposure increasing the risk by 3%.

At the same time, the drug significantly reduced the risk of Aspergillus colonization, especially in the first year after transplant, but not development of aspergillosis. The all-cause mortality was reduced among transplant recipients who developed Aspergillus colonization but had no significant impact on those without colonization, according to the results.

“Among lung transplant recipients with risk factors for SCC, including those with older age, male sex and white race or those in whom prolonged voriconazole administration may not have clear benefit, transplant physicians should consider limiting exposure to high doses of voriconazole or using alternative pharmacologic options that do not pose an increased risk for SCC,” lead author Matthew Mansh, MD, said in a UCSF press release.
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