Treatment Options for Invasive Aspergillosis, Mucormycosis Expanding

The development of mold-active azoles has led to enormous advancements in both prevention and treatment of invasive fungal infections.

Having effective and safe options to treat invasive aspergillosis (IA) and invasive mucormycosis are key, as these infections in patients with cancer remain an important cause of morbidity and mortality.

The development of mold-active azoles has led to enormous advancements in both prevention and treatment of invasive fungal infections, and stratifying patients by risk, either high or low risk of invasive fungal infections, can help to guide treatment decisions.

Available antifungal agents include polyenes, echinocandins, and for more than a decade now, triazoles. Data about most of these agents as they relate to treating invasive mucormycosis are limited; however, it is known that echinocandins are ineffective against infections caused by Mucorales and are approved as salvage therapy for refractory IA.

“The most important thing [for practitioners to know] is the differences between the antifungals so they can best counsel patients about using them,” Contagion®’s editor-in-chief, Jason Gallagher, PharmD, FCCP, BCPS, clinical professor, Temple University School of Pharmacy explained in an interview with Contagion®’s sister publication Pharmacy Times, after an Astellas Pharma-supported product theatre at the American Society of Health System Pharmacists Midyear Clinical Meeting and Exhibition held in Orlando, Florida, during which he discussed antifungal options for fungal infections.

Dr. Gallagher noted that voriconazole-resistant organisms have become more of a problem as clinicians use voriconazole for prophylaxis and as generic options have become available. This has prompted the need for additional treatment options as breakthrough fungal infections occur.

One such agent he discussed was, isavuconazole (Cresemba, Astellas Pharma), which was approved within the past 2.5 years, and has demonstrated efficacy against mucormycosis. The results of 2 trials—a comparative clinical trial of patients who received either isavuconazole or voriconazole for invasive aspergillosis, and an open-label study of patients with mucormycosis—led to US Food and Drug Administration approval of Cresemba for treating IA and invasive mucormycosis in 2015. In addition, according to a review of those studies, published in DovePress, “clinical responses occurred across the range of isavuconazole minimal inhibitory concentrations (MICs) and trough levels observed,” implying that pharmacokinetic monitoring is not necessary when using isavuconazole, which may be favorable.

According to the review, the most common adverse events associated with isavuconazole were gastrointestinal. Toxicities are agent-specific, said Dr. Gallagher.

An earlier version of this article was published on PharmacyTimes.com.