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Pneumocystis jirovecii Pneumonia in Patients With Metastatic Prostate Cancer on Corticosteroids for Malignant Spinal

Cassandra Duarte, Danielle Gilbert, Alison D Sheridan

    Oncology (Williston Park, N.Y.)
    |March 27, 2020
    PubMed

    Insights

    Patients with solid tumors receiving high-dose steroids for metastatic spinal cord compression face a high risk of Pneumocystis jirovecii pneumonia (PCP). Prophylaxis with trimethoprim-sulfamethoxazole or dapsone is recommended to reduce mortality.

    Area of Science:

    • Infectious Diseases
    • Oncology
    • Pulmonology

    Background:

    • Pneumocystis jirovecii pneumonia (PCP) is increasingly diagnosed in non-HIV infected individuals.
    • Solid tumor patients are at risk due to chemotherapy, steroids, and cancer-induced immunosuppression.
    • Metastatic spinal cord compression (MSCC) in solid tumor patients significantly elevates PCP risk.

    Observation:

    • Two cases of MSCC due to prostate cancer treated with corticosteroids are presented.
    • These cases illustrate challenges in predicting corticosteroid therapy duration.
    • Lack of appropriate PCP prophylaxis poses significant danger to these patients.

    Findings:

    • Patients with solid tumors and PCP have higher mortality than HIV-infected patients.
    • Current guidelines for PCP prophylaxis in MSCC patients are reviewed.
    • Empiric trimethoprim-sulfamethoxazole or dapsone for sulfa-allergic patients is recommended for solid tumor patients on high-dose steroids for MSCC.

    Implications:

    • The findings highlight the critical need for PCP prophylaxis in solid tumor patients undergoing treatment for MSCC.
    • Further research is required to understand PCP epidemiology in solid tumor patients.
    • Additional clinical trials are necessary to optimize PCP prophylaxis strategies.

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