Dalia A. Hamdy
Alexandria University,Egypt
Title: Azole Antifungals: A prophylactic Therapy in Hematological Patients
Biography
Biography: Dalia A. Hamdy
Abstract
Acute Lymphoblastic Leukemia (ALL) is one of the most common malignancies. Vincristine (VCR) is widely used in the treatment of ALL worldwide. Its antineoplastic effect may be accompanied by dose and duration of treatment dependent neurological side effects, with most symptoms disappearing by about the sixth week after discontinuation of therapy. Azole antifungals are commonly used as prophylaxis therapy in such treatment regimens. Posaconazole (PSZ), a structural analogue of itraconazole, is a new triazole antifungal agent that has been approved for the prophylaxis of invasive Aspergillus and Candida infections in severely immunocompromised patients. Those immunocompromised patients include those with hematopoietic stem cell transplantation with graft-versus-host disease or hematologic malignancies with prolonged neutropenia from chemotherapy. PSZ has been used for this indication since 2005 in several countries. Co-administration of azoles (as prophylaxis or treatment of fungal infections) and VCR have been shown to increase VCR neurotoxic effects due to the inhibition of cytochrome P450 (CYP) isoform 3A4, for which VCR is a substrate. Concomitant disease conditions were shown to possibly alter the pharmacokinetic (PK), pharmacodynamic and toxicodynamic properties of drugs. Therefore, it is important to test the effect of alteration in PSZ PK and/or its drug interaction with VCR that accompany those concomitant disease conditions. The impact on the clinical decisions needs to be also considered
