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Voriconazole may increase squamous cell carcinoma risk in hematopoietic transplant setting

Voriconazole was associated with a statistically significant increase in cutaneous squamous cell carcinoma risk in a cohort of individuals who underwent hematopoietic cell transplantation.

For the retrospective cohort study, researchers assessed 1,220 patients who underwent allogeneic hematopoietic cell transplantation and 1,418 who underwent autologous hematopoietic cell transplantation to determine nonmelanoma skin cancer risk. In addition to squamous cell carcinoma, the investigators also evaluated basal cell carcinoma risk.

Multivariable analysis results indicated that voriconazole yielded a significant increase in nonmelanoma skin cancer risk (HR = 1.82; 95% CI, 1.13-2.91) in the allogeneic group. The squamous cell carcinoma risk associated with voriconazole was higher in the allogeneic group (HR = 2.25; 95% CI, 1.3-3.89). However, voriconazole use did not increase nonmelanoma skin cancer risk of any kind in the autologous transplantation group.

Other findings indicated that the 10-year incidence ratio for nonmelanoma skin cancer was 27.4 in the allogeneic arm. The median time from transplantation to nonmelanoma skin cancer diagnosis was 2.9 years (range, 0.1-9.9) among patients treated with voriconazole, whereas this duration was 0.7 years (range, 0.1-9.9) among patients not treated with voriconazole.

A history of voriconazole use was associated with a median duration from transplantation to nonmelanoma skin cancer diagnosis of 1.1 years (range, 0.2-5.7), compared with 1.8 years (range, 0.3-10.9) for patients with no history of voriconazole use.

“Our data indicate that history of voriconazole exposure increases the risk for [squamous cell carcinoma] in those who have undergone allogeneic [hematopoietic cell transplantation],” the researchers concluded. “Although other factors have greater impact on the risk for [nonmelanoma skin cancer] in those who have undergone [hematopoietic cell transplantation], the widely-accepted use of voriconazole as either a therapeutic or prophylactic antifungal agent in patients who have undergone [hematopoietic cell transplantation] makes it an important risk factor to consider.” – by Rob Volansky

Disclosure: The researchers report no relevant financial disclosures.