Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jun;36(3):236-258.
doi: 10.37201/req/013.2023. Epub 2023 Apr 5.

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

J R Azanza  1 , J Mensa, J Barberán, L Vázquez, J Pérez de Oteyza, M Kwon, L Yáñez, J M Aguado, A Cubillo Gracian, C Solano, I Ruiz Camps, J Fortún, M Salavert Lletí, C Gudiol, T Olave Rubio, C Solano, C García-Vidal, M Rovira Tarrats, M Suárez-Lledó Grande, P González-Sierra, C Dueñas Gutiérrez
Affiliations
Review

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

J R Azanza et al. Rev Esp Quimioter. 2023 Jun.

Abstract
in English, Spanish

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.

La administración de antifúngicos con fines terapéuticos y especialmente, profilácticos es casi un constante en el paciente que precisa tratamiento oncohematológico. El intento de evitar o de tratar infecciones por Aspergillus o por Mucor exige la administración de algunos fármacos pertenecientes al grupo de los azoles, entre los que destacan por su actividad frente a estos patógenos, voriconazol, posaconazol e isavuconazol. Un aspecto de gran importancia es el riesgo potencial de interacciones cuando se asocian a alguno de los fármacos antineoplásico utilizados en el tratamiento de los tumores hematológicos, dando lugar a graves complicaciones. En este sentido, acalabrutinib, bortezomid, bosutinib, carfizolid, ciclofosfamida, ciscloporina A, dasatinib, duvelisib, gilteritinib, glasdegib, ibrutinib, imatinib, nilotinib, ponatinib, prednisona, ruxolitinib, tacrolimus, trans-retinoico, trióxido de Arsenio, venetoclax, o cualquiera de los alcaloides de la vinca, representan ejemplos muy evidentes de riesgos en unos casos porque su aclaramiento resulta reducido, en otros porque que se potencia el riesgo de prolongación del QTc, especialmente evidentes cuando el fármaco elegido es voriconazol o posaconazol.

Keywords: Azoles; drug-drug interactions; hematology patients.

PubMed Disclaimer

Conflict of interest statement

JRA has received honoraria for talks on behalf of Pfizer, GSK, Menarini, Shionogi and MSD.

JB has received honoraria for talks on behalf of Pfizer, Gilead, Shionogi, and MSD.

LV has received honoraria for talks on behalf of Astellas, Gilead, MSD, Pfizer, Janssen, Astra Zeneca and GSK, and has received honoraria for consulting from Astellas, Gilead, Pfizer, and GSK

MK has received honoraria for lectures and consulting from Gilead, Jazz, Pfizer

LY has received honoraria for talks on behalf of Janssen, Abbvie, Gilead-Kite, Roche, Novartis, MSD, Pfizer, AstraZeneca, Novartis, Beigene, Lilly, has received honoraria for advisory board from Janssen, Abbvie, Gilead-Kite, Roche, Jazz, Sandoz, Celgene, MSD, Pfizer, AstraZeneca, BeiGene, Lilly, Alexion, and research funds from Janssen

JMA has been a consultant to and on the speakers bureau for Pfizer, Gilead, Merck Sharp and Dohme, and United Medical-Biotoscana.

IRC has received honoraria for talks on behalf of MSD, gilead, Astra Zeneca, Pfizer, GSK, Jansenn, and BMS and has received honoraria for advisory board from Pfizer, GSK, Astra Zeneca, and Gilead

JF has participated in scientific events or received remuneration in the form of research support or oral presentations from Merck, Pfizer, Gilead, MSD, Astellas, Novartis, and Roche.

MS has participated in advisory board or received honoraria for talks on behalf of Gilead, Menarini, MSD, Pfizer and Shionogi

CG received research support from Merck and Pfizer and honoraria for talks sponsored by Merck, Gilead, and Pfizer, and Shionogi.

CG-V has received honoraria for talks on behalf of Gilead Science, MSD, Novartis, Pfizer, Janssen, Menarini, GSK and Sanofi, as well as a grant from Gilead Science, Pfizer, and GSK.

PG-S has participated in advisory board or received honoraria for talks on behalf of Pfizer, MSD, Gilead, Astellas, and Abbvie.

CDG has participated in advisory board or received honoraria for talks on behalf of MSD, Pfizer, Shionogi, Menarini, Gilead, Janssen, ViiV, Roche and GSK

Rest of authors have no conflict of interest.

References

    1. Chagas DF, Diniz LM, Lucas EA, Nogueira PSE. Disseminated fusariosis in a patient with bone marrow aplasia. An Bras Dermatol. 2020. Sep-Oct;95(5):609-614. - PMC - PubMed
    1. Forsythe A, Lewis G, Jordan R, Thompson GR 3rd. US database study: burden and healthcare resource utilization in adults with systemic endemic mycoses and aspergillosis. J Comp Eff Res. 2020. Jun;9(8):573-584. - PubMed
    1. Nucci M, Engelhardt M, Hamed K. Mucormycosis in South America: A review of 143 reported cases. Mycoses. 2019. Sep;62(9):730-738. - PMC - PubMed
    1. Singh S, Fatima Z, Hameed S. Predisposing factors endorsing Candida infections. Infez Med. 2015. Sep;23(3):211-23. - PubMed
    1. Ezeokoli OT, Gcilitshana O, Pohl CH. Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants. J Fungi. (Basel) 2021. Jul 9;7(7):545. - PMC - PubMed

MeSH terms