Recommendations on the use of azole antifungals in hematology-oncology patients
José Ramón Azanza Perea, José Mensa, José Barberán, Lourdes Vázquez, Jaime Pérez de Oteyza, Mi Kwon, Lucrecia Yáñez, José María Aguado, Antonio Cubillo Gracián, Carlos Solano, Isabel Ruíz-Camps, Jesús Fortün, Miguel Salavert Lletí, Carlota Gudiol, Teresa Olave Rubio, Carolina García‐Vidal, Montserrat Rovira Tarrats, María Suárez-Lledó Grande, Pedro Antonio González Sierra, Carlos Dueñas Gutiérrez
Abstract
The administration of antifungals for therapeutic and, especially, prophylactic purposes is virtually a constant in patients requiring hematology-oncology treatment. Any attempt to prevent or treat Aspergillus or Mucor infections requires the administration of some drugs in the azole group, which include voriconazole, posaconazole and isavuconazole, noted for their activity against these pathogens. One very relevant aspect is the potential risk of interaction when associated with one of the antineoplastic drugs used to treat hematologic tumors, with serious complications. In this regard, acalabrutinib, bortezomib, bosutinib, carfilzomib, cyclophosphamide, cyclosporine A, dasatinib, duvelisib, gilteritinib, glasdegib, ibrutinib, imatinib, nilotinib, ponatinib, prednisone, ruxolitinib, tacrolimus, all-transretinoic acid, arsenic trioxide, venetoclax, or any of the vinca alkaloids, are very clear examples of risk, in some cases because their clearance is reduced and in others because of increased risk of QTc prolongation, which is particularly evident when the drug of choice is voriconazole or posaconazole.