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Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
Therapeutic Drug Monitoring-Guided Antifungal Therapy Under Tyrosine Kinase Inhibitor Treatment in an Advanced
Ruiting Wen1, Wentao Ni2, Xiaotong Gu1,3
1Department of Pharmacy, Peking University People's Hospital, Beijing, People's Republic of China.
Abstract:
Antifungal therapy for invasive pulmonary aspergillosis (IPA) can be challenging in cancer patients due to interpatient variability in pharmacokinetic properties of antifungals and potential drug-drug interactions (DDIs). This case report describes a 14-year-old boy with advanced osteosarcoma diagnosed with invasive pulmonary aspergillosis (IPA) after chemotherapy. Initial treatment of voriconazole showed poor improvement, as therapeutic drug monitoring (TDM) revealed exceptionally low trough concentration (0.28 μg/mL) even after dose increase. When voriconazole was switched to isavuconazole, favorable antifungal response was observed with isavuconazole trough concentrations ranging from 2.43 μg/mL to 4.12 μg/mL. Moreover, TDM also detected no obvious pharmacokinetic DDI between isavuconazole and apatinib but potential DDI between voriconazole and anlotinib in this patient. This case highlights the importance of individualized pharmacokinetic considerations in antifungal therapy in cancer patients. TDM may be a useful aid for therapeutic regimen decision and optimization.
Insights
Antifungal therapy for invasive pulmonary aspergillosis (IPA) in cancer patients requires personalized dosing. Therapeutic drug monitoring guided a switch from voriconazole to isavuconazole, improving outcomes and managing drug interactions.
Area of Science:
- Medical Mycology
- Pharmacokinetics
- Oncology
Background:
- Invasive pulmonary aspergillosis (IPA) poses a significant challenge in immunocompromised cancer patients.
- Antifungal drug efficacy is often limited by interpatient pharmacokinetic variability and drug-drug interactions (DDIs).
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