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Are we making progress in antifungal therapy?
1Department of Cellular Biotechnology and Hematology, University La Sapienza, Rome, Italy.
Abstract:
Contrary to the case with bacterial infections, progress in the diagnosis and treatment of invasive mycoses in cancer patients has been unsatisfactory. Amphotericin B deoxycholate has remained the drug of choice for severe invasive fungal infections for nearly 40 years. However, its infusion-related side effects, as well as its toxicity, may at times lead to dose reduction or early discontinuation of the treatment. The introduction of the new triazoles, fluconazole and itraconazole, has improved the therapeutic chances against several fungal infections; however, the need for a broad-spectrum drug in empiric antifungal therapy, the emergence of fluconazole-resistant Candida species, and the limitations of itraconazole in terms of speed action and erratic oral absorption represent important limitations. Recently, laboratory and clinical research has been directed at the development of new formulations of older classes of antifungals, the introduction of new classes of antifungals, and the use of immunomodulation associated with antifungal therapy. This paper reviews the more recent advances in the treatment of fungal infections in cancer patients.
Insights
Treatment for invasive fungal infections in cancer patients remains challenging. Recent advances focus on new antifungal drugs and therapies to improve outcomes for these vulnerable patients.
Area of Science:
- Mycology
- Oncology
- Infectious Diseases
Background:
- Invasive mycoses in cancer patients have seen limited therapeutic progress.
- Amphotericin B deoxycholate, despite toxicity, remains a primary treatment for severe fungal infections.
- Newer azoles like fluconazole and itraconazole offer improvements but have limitations, including resistance and absorption issues.
Purpose of the Study:
- To review recent advancements in treating fungal infections in cancer patients.
- To highlight challenges in current antifungal therapy for immunocompromised individuals.
- To discuss emerging strategies beyond traditional antifungal agents.
Main Methods:
- Review of recent laboratory and clinical research.
- Analysis of new antifungal formulations and drug classes.
- Exploration of immunomodulation in conjunction with antifungal therapy.
Main Results:
- Development of novel antifungal formulations and new drug classes is ongoing.
- Emergence of antifungal resistance necessitates broader-spectrum agents.
- Combination therapy, including immunomodulation, shows promise.
Conclusions:
- Significant unmet needs persist in managing invasive mycoses in cancer patients.
- Advances in antifungal drug development are crucial for improving patient survival.
- Future strategies involve novel agents, improved formulations, and combination therapies.