Recommendations on the use of azole antifungals in hematology-oncology patients

The administration of antifungals for therapeutic and, especially, prophylactic purposes is virtually a constant in patients requiring hematology-oncology treatment. Any attempt to prevent or treat Aspergillus or Mucor infections requires the administration of some drugs in the azole group, which include voriconazole, posaconazole and isavuconazole, noted for their activity against these pathogens. One very relevant aspect is the potential risk of interaction when associated with one of the antineoplastic drugs used to treat hematologic tumors, with serious complications. In this regard, acalabrutinib, bortezomib, bosutinib, carfilzomib, cyclophosphamide, cyclosporine A, dasatinib, duvelisib, gilteritinib, glasdegib, ibrutinib, imatinib, nilotinib, ponatinib, prednisone, ruxolitinib, tacrolimus, all-transretinoic acid, arsenic trioxide, venetoclax, or any of the vinca alkaloids, are very clear examples of risk, in some cases because their clearance is reduced and in others because of increased risk of QTc prolongation, which is particularly evident when the drug of choice is voriconazole or posaconazole.

 

Comments：

It is true that the administration of antifungal drugs is essential in patients receiving hematology-oncology treatment, particularly for preventing or treating Aspergillus or Mucor infections. However, it is important to note that there is a potential risk of drug interactions when these antifungal drugs are used in combination with certain antineoplastic drugs used to treat hematologic tumors, which can lead to serious complications.

Some examples of antineoplastic drugs that can interact with antifungal drugs include acalabrutinib, bortezomib, bosutinib, carfilzomib, cyclophosphamide, cyclosporine A, dasatinib, duvelisib, gilteritinib, glasdegib, ibrutinib, imatinib, nilotinib, ponatinib, prednisone, ruxolitinib, tacrolimus, all-transretinoic acid, arsenic trioxide, venetoclax, and any of the vinca alkaloids. These drugs can affect the clearance of antifungal drugs, leading to increased levels of these drugs in the bloodstream and potentially causing toxicity. Additionally, some of these drugs can increase the risk of QTc prolongation, which is a potential side effect of some antifungal drugs such as voriconazole or posaconazole.

Therefore, it is crucial to carefully monitor patients receiving these drugs in combination and adjust the dosages accordingly to minimize the risk of drug interactions and potential complications. It is also important to educate patients and healthcare providers about the potential risks and to report any adverse effects or symptoms promptly to their healthcare provider.

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