Invasive pulmonary aspergillosis in patients with solid tumours: risk factors and predictors of clinical outcomes

Abstract

IPA should be considered in patients with solid tumours, particularly those with underlying lung disease. Key messages Invasive pulmonary aspergillosis should be considered in patients with solid tumours, particularly those with underlying lung disease, lung cancer and those who received chest radiotherapy. Most of the patients with invasive pulmonary aspergillosis and solid tumours presented with nonspecific symptoms and signs as well as nonspecific CT findings. Unlike patients with hematologic malignancies, fever and hemoptysis were not predominant symptoms and the classical halo sign and the air-crescent sign were not described. Independent risk factors for 12-week mortality included receiving steroids within 30 days of diagnosis and chest radiotherapy. In multivariate analysis, a positive fungal stain was associated with lower odds of a successful response to antifungal therapy, whereas voriconazole treatment was associated with higher odds.

Invasive Pulmonary Aspergillosis

“…Risk of developing IA or subacute IA also exists in solid tumor patients. 71,72 The rate is, however, much lower than in patients with hematologic malignancies. In a study on 452 patients with a positive Aspergillus culture, the vast majority (n ¼ 351, 78%) were colonized and 101 had invasive infections.…”

“…In a study on 452 patients with a positive Aspergillus culture, the vast majority (n ¼ 351, 78%) were colonized and 101 had invasive infections. 71 The most common underlying tumors were lung cancers, head and neck cancers, gastrointestinal cancers, and breast cancers. Underlying respiratory disease, prior chest radiation, use of steroids were the predisposing factors most often identified in these patients.…”

A patient with hepatocellular carcinoma who developed invasive pulmonary aspergillosis after corticosteroid treatment

“…We report a case of IPA occurring three weeks after the initiation of corticosteroid treatment for hepatocellular carcinoma. Most solid tumors associated with IPA are reported to be lung or head and neck cancers, 5 but to the best of our knowledge, there have been no previous reports of cases of coexisting hepatocellular carcinoma. We suspect that the development of IPA was induced by the addition of corticosteroid to hepatocellular carcinoma in the background of cirrhosis, and prophylactic administration of antifungal drugs may be an option to consider when corticosteroid is used, especially in patients with cirrhosis.…”

A patient with hepatocellular carcinoma who developed invasive pulmonary aspergillosis after corticosteroid treatment

“…We report a case of IPA occurring three weeks after the initiation of corticosteroid treatment for hepatocellular carcinoma. Most solid tumors associated with IPA are reported to be lung or head and neck cancers [4], but to the best of our knowledge, there have been no previous reports of cases of coexisting hepatocellular carcinoma. We suspect that the development of IPA was induced by the addition of corticosteroid to hepatocellular carcinoma in the background of cirrhosis, and prophylactic administration of antifungal drugs may be an option to consider when corticosteroid is used, especially in patients with cirrhosis.…”

“…However, patients with these various conditions were frequently excluded from past studies of antifungal agents, and often, they do not meet the European Organization for Research and Treatment of Cancer/Invasive Infectious Diseases Study Mycoses Group diagnostic criteria of IPA, leaving several clinical aspects unexplored [6]. Limited reports indicate that the prevalence of IPA in solid tumors ranges from 0.7 to 2.6% [7,8]. The most common type of cancer is lung cancer, followed by head and neck, breast, and gastrointestinal cancers, but there have been no reports of hepatocellular carcinoma.…”