A study conducted by researchers at the University of California San Francisco (UCSF) has showed that voriconazole, a prescription drug commonly used to treat fungal infections in lung transplant patients, significantly increases the risk of skin cancer and can even cause death.
Researchers have recommended that physicians consider patient-specific factors that could modify voriconazole’s risks and benefits, when providing care.
Skin cancer is the most common malignancy following solid organ transplants, mainly due to immunosuppression.
Compared with the general population, recipients with organ transplants are experiencing a greater than 65-fold increased risk of developing cutaneous squamous cell carcinoma (SCC).
UCSF High Risk Skin Cancer Clinic director and associate professor of dermatology Sarah Arron said: "It is important for physicians to be aware of the impact of voriconazole on these outcomes.
"We recommend that all providers counsel lung transplant recipients on skin cancer risk and photoprotection, in addition to scheduling routine skin cancer screening with a trained dermatologist after transplantation.
"Lung transplant programmes should also consider patient-specific risk factors when deciding on the type, dose and duration of antifungal prophylaxis regimens."
Due to the older age at transplant and more intensive immunosuppression, lung transplant recipients are particularly susceptible to SCC and they also have high rates of fungal infections after transplantation.
Initially, voriconazole was approved in 2002 to prevent and treat invasive fungal infections such as those caused by the Aspergillus fungi, especially in patients with compromised immune systems such as those having had a lung or other organ transplant.
The Aspergillus fungi can cause aspergillosis, a variety of diseases often occurring in people with healthy immune systems but having an underlying illness such as tuberculosis or chronic obstructive pulmonary disease (COPD).
In the study, researchers evaluated all UCSF single-lung, double-lung or heart-lung transplant recipients receiving a transplant between October 1991 and December 2012.
A total of 455 individuals were analysed for voriconazole exposure and its impact on SCC, Aspergillus colonisation, invasive aspergillosis and all-cause mortality.
Data from the study showed that voriconazole exposure resulted in a 73% greater risk for SCC, with each additional 30-day exposure increasing the risk by 3%.
The study showed that the drug significantly reduced the risk of Aspergillus colonisation, especially in the first year after transplant, but not aspergillosis.
The drug also reduced all-cause mortality among those transplant recipients who developed Aspergillus colonisation but had no significant impact on those without colonisation.
UCSF Department of Dermatology lead author Matthew Mansh said: "Among lung transplant recipients with risk factors for SCC, including those with older age, male sex and white race or those in whom prolonged voriconazole administration may not have clear benefit, transplant physicians should consider limiting exposure to high doses of voriconazole or using alternative pharmacologic options that do not pose an increased risk for SCC."
Image: Voriconazole, a variety of triazole, was developed by Pfizer and is sold in the US under the brand name Vfend. Photo: courtesy of NLM.