Efficacy of caspofungin against invasive Candida or invasive Aspergillus infections in neutropenic patients

Robert Betts, Axel Glasmacher, Johan Maertens, Georg Maschmeyer, Jose A. Vazquez, Hedy Teppler, Arlene Taylor, Robert Lupinacci, Carole Sable, Nicholas Kartsonis

Research output: Contribution to journalReview article

66 Citations (Scopus)

Abstract

BACKGROUND. Neutropenia is an indicator of poor prognosis in patients with fungal infections. All available clinical trial experience from the caspofungin development program was reviewed to ascertain the efficacy of caspofungin in neutropenic patients with documented invasive aspergillosis (IA) or invasive candidiasis (IC). METHODS. The review was limited to neutropenic patients with proven IC or proven/probable IA at caspofungin onset. Data were available from four clinical trials. All patients had an absolute neutrophil count < 500/mm3 at the initiation of caspofungin. In all cases caspofungin was administered as monotherapy at a dose of 50 mg/day, after a 70-mg loading dose. In all patients efficacy was assessed at the completion of caspofungin therapy. Success included complete and partial responses. RESULTS. Sixty-eight neutropenic patients were identified with documented invasive infection, including 27 with IC and 41 with IA. Most patients had acute or chronic leukemia. A favorable response was noted in 63% (17 of 27 patients) of patients with IC, including a 58% (14 of 24 patients) response as first-line therapy and a 100% (3 of 3 patients) response as salvage therapy. Success in candidemia was 68% (17 of 25 patients). Outcomes across the different Candida species were similar. Favorable responses were noted in 39% (16 of 41 patients) of patients with IA, including a 42% (5 of 12 patients) response as first-line therapy and 38% (11 of 29 patients) response as salvage therapy. Success by site of IA was 40% for pulmonary (12 of 30 patients), 43% for sinus (3 of 7 patients), and 25% for skin/disseminated site (1 of 4 patients). CONCLUSIONS. A review of the caspofungin database demonstrates that this echinocandin is effective in neutropenic patients with documented cases of IC or IA.

Original languageEnglish (US)
Pages (from-to)466-473
Number of pages8
JournalCancer
Volume106
Issue number2
DOIs
StatePublished - Jan 15 2006

Fingerprint

caspofungin
Aspergillus
Candida
Infection
Invasive Candidiasis
Aspergillosis
Salvage Therapy

Keywords

  • Aspergillosis
  • Candidiasis
  • Caspofungin
  • Neutropenia

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Betts, R., Glasmacher, A., Maertens, J., Maschmeyer, G., Vazquez, J. A., Teppler, H., ... Kartsonis, N. (2006). Efficacy of caspofungin against invasive Candida or invasive Aspergillus infections in neutropenic patients. Cancer, 106(2), 466-473. https://doi.org/10.1002/cncr.21615

Efficacy of caspofungin against invasive Candida or invasive Aspergillus infections in neutropenic patients. / Betts, Robert; Glasmacher, Axel; Maertens, Johan; Maschmeyer, Georg; Vazquez, Jose A.; Teppler, Hedy; Taylor, Arlene; Lupinacci, Robert; Sable, Carole; Kartsonis, Nicholas.

In: Cancer, Vol. 106, No. 2, 15.01.2006, p. 466-473.

Research output: Contribution to journalReview article

Betts, R, Glasmacher, A, Maertens, J, Maschmeyer, G, Vazquez, JA, Teppler, H, Taylor, A, Lupinacci, R, Sable, C & Kartsonis, N 2006, 'Efficacy of caspofungin against invasive Candida or invasive Aspergillus infections in neutropenic patients', Cancer, vol. 106, no. 2, pp. 466-473. https://doi.org/10.1002/cncr.21615
Betts, Robert ; Glasmacher, Axel ; Maertens, Johan ; Maschmeyer, Georg ; Vazquez, Jose A. ; Teppler, Hedy ; Taylor, Arlene ; Lupinacci, Robert ; Sable, Carole ; Kartsonis, Nicholas. / Efficacy of caspofungin against invasive Candida or invasive Aspergillus infections in neutropenic patients. In: Cancer. 2006 ; Vol. 106, No. 2. pp. 466-473.
@article{c3d6142b521e443ca86ca9410f7e0d7e,
title = "Efficacy of caspofungin against invasive Candida or invasive Aspergillus infections in neutropenic patients",
abstract = "BACKGROUND. Neutropenia is an indicator of poor prognosis in patients with fungal infections. All available clinical trial experience from the caspofungin development program was reviewed to ascertain the efficacy of caspofungin in neutropenic patients with documented invasive aspergillosis (IA) or invasive candidiasis (IC). METHODS. The review was limited to neutropenic patients with proven IC or proven/probable IA at caspofungin onset. Data were available from four clinical trials. All patients had an absolute neutrophil count < 500/mm3 at the initiation of caspofungin. In all cases caspofungin was administered as monotherapy at a dose of 50 mg/day, after a 70-mg loading dose. In all patients efficacy was assessed at the completion of caspofungin therapy. Success included complete and partial responses. RESULTS. Sixty-eight neutropenic patients were identified with documented invasive infection, including 27 with IC and 41 with IA. Most patients had acute or chronic leukemia. A favorable response was noted in 63{\%} (17 of 27 patients) of patients with IC, including a 58{\%} (14 of 24 patients) response as first-line therapy and a 100{\%} (3 of 3 patients) response as salvage therapy. Success in candidemia was 68{\%} (17 of 25 patients). Outcomes across the different Candida species were similar. Favorable responses were noted in 39{\%} (16 of 41 patients) of patients with IA, including a 42{\%} (5 of 12 patients) response as first-line therapy and 38{\%} (11 of 29 patients) response as salvage therapy. Success by site of IA was 40{\%} for pulmonary (12 of 30 patients), 43{\%} for sinus (3 of 7 patients), and 25{\%} for skin/disseminated site (1 of 4 patients). CONCLUSIONS. A review of the caspofungin database demonstrates that this echinocandin is effective in neutropenic patients with documented cases of IC or IA.",
keywords = "Aspergillosis, Candidiasis, Caspofungin, Neutropenia",
author = "Robert Betts and Axel Glasmacher and Johan Maertens and Georg Maschmeyer and Vazquez, {Jose A.} and Hedy Teppler and Arlene Taylor and Robert Lupinacci and Carole Sable and Nicholas Kartsonis",
year = "2006",
month = "1",
day = "15",
doi = "10.1002/cncr.21615",
language = "English (US)",
volume = "106",
pages = "466--473",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "2",

}

TY - JOUR

T1 - Efficacy of caspofungin against invasive Candida or invasive Aspergillus infections in neutropenic patients

AU - Betts, Robert

AU - Glasmacher, Axel

AU - Maertens, Johan

AU - Maschmeyer, Georg

AU - Vazquez, Jose A.

AU - Teppler, Hedy

AU - Taylor, Arlene

AU - Lupinacci, Robert

AU - Sable, Carole

AU - Kartsonis, Nicholas

PY - 2006/1/15

Y1 - 2006/1/15

N2 - BACKGROUND. Neutropenia is an indicator of poor prognosis in patients with fungal infections. All available clinical trial experience from the caspofungin development program was reviewed to ascertain the efficacy of caspofungin in neutropenic patients with documented invasive aspergillosis (IA) or invasive candidiasis (IC). METHODS. The review was limited to neutropenic patients with proven IC or proven/probable IA at caspofungin onset. Data were available from four clinical trials. All patients had an absolute neutrophil count < 500/mm3 at the initiation of caspofungin. In all cases caspofungin was administered as monotherapy at a dose of 50 mg/day, after a 70-mg loading dose. In all patients efficacy was assessed at the completion of caspofungin therapy. Success included complete and partial responses. RESULTS. Sixty-eight neutropenic patients were identified with documented invasive infection, including 27 with IC and 41 with IA. Most patients had acute or chronic leukemia. A favorable response was noted in 63% (17 of 27 patients) of patients with IC, including a 58% (14 of 24 patients) response as first-line therapy and a 100% (3 of 3 patients) response as salvage therapy. Success in candidemia was 68% (17 of 25 patients). Outcomes across the different Candida species were similar. Favorable responses were noted in 39% (16 of 41 patients) of patients with IA, including a 42% (5 of 12 patients) response as first-line therapy and 38% (11 of 29 patients) response as salvage therapy. Success by site of IA was 40% for pulmonary (12 of 30 patients), 43% for sinus (3 of 7 patients), and 25% for skin/disseminated site (1 of 4 patients). CONCLUSIONS. A review of the caspofungin database demonstrates that this echinocandin is effective in neutropenic patients with documented cases of IC or IA.

AB - BACKGROUND. Neutropenia is an indicator of poor prognosis in patients with fungal infections. All available clinical trial experience from the caspofungin development program was reviewed to ascertain the efficacy of caspofungin in neutropenic patients with documented invasive aspergillosis (IA) or invasive candidiasis (IC). METHODS. The review was limited to neutropenic patients with proven IC or proven/probable IA at caspofungin onset. Data were available from four clinical trials. All patients had an absolute neutrophil count < 500/mm3 at the initiation of caspofungin. In all cases caspofungin was administered as monotherapy at a dose of 50 mg/day, after a 70-mg loading dose. In all patients efficacy was assessed at the completion of caspofungin therapy. Success included complete and partial responses. RESULTS. Sixty-eight neutropenic patients were identified with documented invasive infection, including 27 with IC and 41 with IA. Most patients had acute or chronic leukemia. A favorable response was noted in 63% (17 of 27 patients) of patients with IC, including a 58% (14 of 24 patients) response as first-line therapy and a 100% (3 of 3 patients) response as salvage therapy. Success in candidemia was 68% (17 of 25 patients). Outcomes across the different Candida species were similar. Favorable responses were noted in 39% (16 of 41 patients) of patients with IA, including a 42% (5 of 12 patients) response as first-line therapy and 38% (11 of 29 patients) response as salvage therapy. Success by site of IA was 40% for pulmonary (12 of 30 patients), 43% for sinus (3 of 7 patients), and 25% for skin/disseminated site (1 of 4 patients). CONCLUSIONS. A review of the caspofungin database demonstrates that this echinocandin is effective in neutropenic patients with documented cases of IC or IA.

KW - Aspergillosis

KW - Candidiasis

KW - Caspofungin

KW - Neutropenia

UR - http://www.scopus.com/inward/record.url?scp=30344440759&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=30344440759&partnerID=8YFLogxK

U2 - 10.1002/cncr.21615

DO - 10.1002/cncr.21615

M3 - Review article

C2 - 16353208

AN - SCOPUS:30344440759

VL - 106

SP - 466

EP - 473

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 2

ER -