A common drug often prescribed to treat fungal infections in lung transplant recipients could also increase the risk of skin cancer and death in these patients, according to the findings of a new study.
Researchers from the University of California-San Francisco (UCSF) made their discovery after investigating lung transplant recipients for exposure to the drug voriconazole alongside fungal infections, skin cancer and all-cause mortality.
“It is important for physicians to be aware of the impact of voriconazole on these outcomes,” states senior author Dr. Sarah Arron, associate professor of dermatology and director of the UCSF High Risk Skin Cancer Clinic.
The study authors recommend that all health care providers counsel lung transplant recipients on skin cancer risk and light protection alongside routine skin cancer screening following transplantation.
“Lung transplant programs should also consider patient-specific risk factors when deciding on the type, dose and duration of antifungal prophylaxis regimens,” Dr. Arron adds.
Skin cancer is the most common form of cancer to develop following solid organ transplants, with transplant recipients facing an increased risk of developing cutaneous squamous cell carcinoma (SCC) 65 times greater than that faced by the general population.
SCC is an aggressive form of cancer and its treatment often involves multiple debilitating forms of surgery. Recipients of lung transplants are known to be particularly at risk from SCC on account of requiring more intensive immunosuppression therapy and typically undergoing transplantation at an older age than patients receiving other solid organs.
Lung transplant recipients are also at an increased risk of fungal infections after transplant, such as those caused by the Aspergillus fungi.
Infection from this fungus can lead to a condition known as aspergillosis, a group of diseases that typically occur in people with healthy immune systems who have underlying conditions such as chronic obstructive pulmonary disease (COPD).
Voriconazole was first approved to prevent and treat invasive fungal infections in 2002. Unfortunately, SCC is a serious side effect of voriconazole and, despite its widespread use, there are currently no clear guidelines for courses of treatment involving the drug.
For the study, the researchers examined the cases of all 455 single-lung, double-lung and heart-lung transplant recipients who received their transplants at UCSF between October 1991 and December 2012.
Each patient was assessed for exposure to voriconazole, with the researchers looking to see how the drug impacted on SCC, Aspergillus colonization, aspergillosis and all-cause mortality.
The researchers found that the risk for SCC increased by 73% with exposure to voriconazole, with the risk increasing alongside the length of exposure to the drug. For each additional 30 days the transplant recipients were exposed to voriconazole, their risk of SCC increased by 3%.
While voriconazole reduced the risk of Aspergillus colonization, the researchers also discovered that exposure to the drug did not reduce the risk of aspergillosis. Exposure to the drug was also linked to the reduction of all-cause mortality in patients who developed Aspergillus colonization but not in those who did not.
Lead author Dr. Matthew Mansh concludes:
“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.”
The study is published in the American Journal of Transplantation.
Recently, Medical News Today reported on a study finding that patients who undergo organ transplantation are at a greater risk of developing melanoma and dying from the disease than individuals who do not receive transplants.