Voriconazole may increase risk for squamous cell carcinoma in allogeneic HCT patients
Use of voriconazole appears to increase the risk specifically for squamous cell carcinoma (SCC) in the allogeneic haematopoietic cell transplantation (HCT) population, according to a recent study.
To examine the effect of voriconazole on the risk for nonmelanoma skin cancer (NMSC), including SCC and basal cell carcinoma, researchers conducted a retrospective cohort study involving 1,220 individuals who had undergone allogeneic HCT and 1,418 who had undergone autologous HCT. Voriconazole exposure and other known risk factors for NMSC were included in multivariate analysis.
Multivariate analyses revealed that using voriconazole elevated the risk for NMSC (hazard ratio [HR], 1.82; 95 percent CI, 1.13 to 2.91) among patients who had undergone allogeneic HCT, particularly for SCC (HR, 2.25; 1.30 to 3.89). In patients who had undergone autologous HCT, using voriconazole did not contribute to an increased risk for NMSC.
In an earlier study, Wojenski and colleagues identified cumulative days of voriconazole use as a predictor of SCC development following allogeneic HCT. This information, according to them, may help guide appropriate antifungal use in this patient population. [Transpl Infect Dis 2015;17:250-8]
Meanwhile, a study by Boast and colleagues on voriconazole dosing and therapeutic drug monitoring (TDM) in children found a significant intra- and interindividual variability in voriconazole concentrations in children, particularly those <6 years of age, which warranted repeated TDM throughout treatment. The authors also recommended standardized guidelines for TDM and dose adjustment in children. [J Antimicrob Chemother 2016;71:2031-6]
The current study is limited by its retrospective design, according to researchers, adding that voriconazole has previously been tied to an increased risk for cutaneous SCC in solid organ transplant recipients.