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Voriconazole increases risk for squamous cell carcinoma, reduces Aspergillus colonization
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Lung transplant recipients exposed to voriconazole demonstrated a significantly increased risk for squamous cell carcinoma, according to study results.
However, voriconazole exposure significantly reduced the risk for Aspergillus colonization, as well as all-cause mortality among patients who developed Aspergillus colonization.
Matthew D. Mansh, BS, of Stanford University School of Medicine, and colleagues performed a retrospective study of voriconazole exposure for 455 lung transplant recipient patients at the University of California, San Francisco, between 1991 and 2012. Inclusion criteria included patients who underwent a single-lung, double-lung or heart–lung transplant at the center, where postoperative day 3 was the index for receiving universal antifungal prophylaxis for 3 months.
Between 1991 and 2002, inhaled amphotericin was used for prevention of Aspergillus colonization and invasive fungal infections; voriconazole was introduced as a treatment for lung transplant recipients in 2002 and replaced inhaled amphotericin in 2005.
Mansh and colleagues used ICD-9 codes to confirm squamous cell carcinoma development, ICD-9 codes and positive cultures to confirm Aspergillus colonization, and positive cultures to confirm invasive aspergillosis diagnoses.
Results showed voriconazole increased the risk for squamous cell carcinoma by 73% (HR = 1.73; 95% CI, 1.04-2.88), and each subsequent 30-day period of voriconazole treatment at the same dose increased the risk by 3% (HR = 1.03; 95% CI, 1.02-1.04).
Voriconazole increased the risk for Aspergillus colonization by 50% (HR = 0.5; 95% CI, 0.34-0.72), and it significantly reduced the risk for all-cause mortality among patients with an Aspergillus colonization (HR = 0.34; 95% CI, 0.13-0.91).
“These findings have important implications for the care of lung transplant recipients. [Squamous cell carcinomas] in solid organ transplant recipients behave aggressively and can result in significantly reduced quality of life, metastatic disease, and increased mortality,” Mansh and colleagues wrote. “It is important for physicians to be aware of the impact of voriconazole on these outcomes.” – by Jeff Craven
Disclosure: The researchers report no relevant financial disclosures.
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