Caspofungin for the treatment of invasive fungal disease in hematological patients (ProCAS Study)

Abstract

Caspofungin is an echinocandin with proven efficacy in invasive candidiasis (IC) and invasive aspergillosis (IA). This multicenter, prospective, non-comparative, observational ProCAS study was aimed to assess the effectiveness and safety of caspofungin in adult hematological patients with IC or IA under everyday clinical conditions. Favorable outcomes included complete and partial responses on the last day of caspofungin therapy. Safety was assessed up to 14 days post-caspofungin. A total of 115 patients (69 male) with a median age of 52 years (range, 23-78 years) were analyzed. Underlying disease was acute myeloid leukemia in 45 patients (39%), and 21 (18%) were allogeneic stem cell transplant recipients. Thirty-four (29.5%) patients had a diagnosis of IA and 26 (22.6%) had IC (candidemia). The median duration of caspofungin therapy was 14 days (range, 1-100). The overall favorable response rate was 77% (20/26) for patients with IC (69% first-line) and 79% (27/34) for those with IA. Antifungal therapy with caspofungin was generally well tolerated, only two (1.7%) patients having a non-serious drug-related adverse reaction. These results suggest that caspofungin, either alone or in combination, should be considered an effective and safe option for the treatment of invasive mycoses in patients with severe hematological disorders.

Salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes: a systematic review and meta-analysis

“…Of the remaining 24 articles, 16 ( k = 16) were included in the initial analysis (Table 1) 14,15,34–48 and eight ( k = 8) were added (echinocandin comparator) in the sensitivity analysis (Table 2). 49–56 Table 3 lists current or withdrawn clinical trials on the topic.…”

Factors influencing recovery in patients with hemoblastoses and candidemia

“…В исследовании I. Jarque и соавт. [20], которое включало больных гемобла-стозами и КЕ, также продемонстрировано, что «восста-новление» нормального числа гранулоцитов ассоцииро-вано с благоприятным исходом у 97% больных, в то время как при сохранении ГЦП излечения достигали только 53% (р=0,0006). По нашим данным, частота излечения также статистически значимо ниже при ГЦП (42% против 88%; p=0,001), особенно при ГЦП длительностью более 20 дней (13% против 73%; p<0,0001).…”

Development and validation of a liquid chromatography/tandem mass spectrometry method for determination of caspofungin in dried blood spots

“…and Aspergillus spp. infections . The antifungal mechanism of caspofungin is the inhibition of β(1,3)‐D‐glucan synthase which is essential for the biosynthesis of the cell wall in fungus, leading to lysis of growing hyphal tips .…”