Long-term Voriconazole and Skin Cancer: is There Cause for Concern?

Overview

Journal Curr Infect Dis Rep

Specialty Infectious Diseases

Date 2011 Oct 15

PMID 21997681

Citations 12

Authors

Cornelius J Clancy

M Hong Nguyen

Affiliations

Soon will be listed here.

Abstract

Skin toxicity due to voriconazole is well recognized. Recently, several series have reported skin cancer, particularly cutaneous squamous cell carcinoma (C-SCC), following photosensitivity reactions among patients receiving long-term voriconazole (>12 months). Almost all patients were immunosuppressed, including stem cell and solid organ transplant recipients. A case-control study of lung transplant recipients identified long-term voriconazole (median cumulative dose: 76 grams) and residence in areas of strong sun exposure as independent risk factors for C-SCC. The mechanism(s) by which voriconazole may predispose to skin cancer is not clear. Moreover, the relative contribution of voriconazole and other factors such as immunosuppression, ultraviolet exposure, advanced age and skin type is unknown. Until further data are available, voriconazole should be used carefully for durations >6-9 months, particularly among patients with risk factors for skin cancer. In patients requiring prolonged voriconazole, diligent skin examinations, avoidance of excess sunlight, and liberal use of UV protectants are advisable.

Citing Articles

Allergic Bronchopulmonary Aspergillosis in Children with Cystic Fibrosis: An Update on the Newest Diagnostic Tools and Therapeutic Approaches.

Lattanzi C, Messina G, Fainardi V, Tripodi M, Pisi G, Esposito S Pathogens. 2020; 9(9).

PMID: 32878014 PMC: 7559707. DOI: 10.3390/pathogens9090716.

Treating Allergic Bronchopulmonary Aspergillosis: A Review.

Patel A, Patel A, Singh S, Singh S, Khawaja I Cureus. 2019; 11(4):e4538.

PMID: 31263646 PMC: 6592456. DOI: 10.7759/cureus.4538.

Cutaneous infection in renal transplant recipients-A report of 2 cases and review of the literature.

Nguyen Y, Dodds T, Lowe P JAAD Case Rep. 2018; 4(5):415-417.

PMID: 29984267 PMC: 6031487. DOI: 10.1016/j.jdcr.2017.11.012.

Allergic Bronchopulmonary Aspergillosis.

Tracy M, Okorie C, Foley E, Moss R J Fungi (Basel). 2018; 2(2).

PMID: 29376934 PMC: 5753079. DOI: 10.3390/jof2020017.

Echinocandin prophylaxis in patients undergoing haematopoietic cell transplantation and other treatments for haematological malignancies.

Epstein D, Seo S, Brown J, Papanicolaou G J Antimicrob Chemother. 2018; 73(suppl_1):i60-i72.

PMID: 29304213 PMC: 7189969. DOI: 10.1093/jac/dkx450.

References

Auffret N, Janssen F, Chevalier P, Guillemain R, Amrein C, Le Beller C . [Voriconazole photosensitivity: 7 cases]. Ann Dermatol Venereol. 2006; 133(4):330-2. DOI: 10.1016/s0151-9638(06)70910-3. View

Euvrard S, Kanitakis J, Pouteil-Noble C, Dureau G, Touraine J, Faure M . Comparative epidemiologic study of premalignant and malignant epithelial cutaneous lesions developing after kidney and heart transplantation. J Am Acad Dermatol. 1995; 33(2 Pt 1):222-9. DOI: 10.1016/0190-9622(95)90239-2. View

Sanchez E, Marubashi S, Jung G, Levy M, Goldstein R, Molmenti E . De novo tumors after liver transplantation: a single-institution experience. Liver Transpl. 2002; 8(3):285-91. DOI: 10.1053/jlts.2002.29350. View

Jensen P, Moller B, Hansen S . Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens. J Am Acad Dermatol. 2000; 42(2 Pt 1):307. DOI: 10.1016/s0190-9622(00)90154-3. View

Amigues I, Cohen N, Chung D, Seo S, Plescia C, Jakubowski A . Hepatic safety of voriconazole after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2010; 16(1):46-52. PMC: 3094157. DOI: 10.1016/j.bbmt.2009.08.015. View

Johnson L, Kauffman C . Voriconazole: a new triazole antifungal agent. Clin Infect Dis. 2003; 36(5):630-7. DOI: 10.1086/367933. View

Vanacker A, Fabre G, Van Dorpe J, Peetermans W, Maes B . Aggressive cutaneous squamous cell carcinoma associated with prolonged voriconazole therapy in a renal transplant patient. Am J Transplant. 2008; 8(4):877-80. DOI: 10.1111/j.1600-6143.2007.02140.x. View

McCarthy K, Playford E, Looke D, Whitby M . Severe photosensitivity causing multifocal squamous cell carcinomas secondary to prolonged voriconazole therapy. Clin Infect Dis. 2007; 44(5):e55-6. DOI: 10.1086/511685. View

Vadnerkar A, Nguyen M, Mitsani D, Crespo M, Pilewski J, Toyoda Y . Voriconazole exposure and geographic location are independent risk factors for squamous cell carcinoma of the skin among lung transplant recipients. J Heart Lung Transplant. 2010; 29(11):1240-4. DOI: 10.1016/j.healun.2010.05.022. View

10.

Cowen E, Nguyen J, Miller D, McShane D, Arron S, Prose N . Chronic phototoxicity and aggressive squamous cell carcinoma of the skin in children and adults during treatment with voriconazole. J Am Acad Dermatol. 2009; 62(1):31-37. PMC: 2815347. DOI: 10.1016/j.jaad.2009.09.033. View

11.

Bruggemann R, Alffenaar J, Blijlevens N, Billaud E, Kosterink J, Verweij P . Clinical relevance of the pharmacokinetic interactions of azole antifungal drugs with other coadministered agents. Clin Infect Dis. 2009; 48(10):1441-58. DOI: 10.1086/598327. View

12.

Murayama N, Imai N, Nakane T, Shimizu M, Yamazaki H . Roles of CYP3A4 and CYP2C19 in methyl hydroxylated and N-oxidized metabolite formation from voriconazole, a new anti-fungal agent, in human liver microsomes. Biochem Pharmacol. 2007; 73(12):2020-6. DOI: 10.1016/j.bcp.2007.03.012. View

13.

Fortina A, Caforio A, Piaserico S, Alaibac M, Tona F, Feltrin G . Skin cancer in heart transplant recipients: frequency and risk factor analysis. J Heart Lung Transplant. 2000; 19(3):249-55. DOI: 10.1016/s1053-2498(99)00137-0. View

14.

Webb M, Compton F, Andrews P, Koffman C . Skin tumours posttransplantation: a retrospective analysis of 28 years' experience at a single centre. Transplant Proc. 1997; 29(1-2):828-30. DOI: 10.1016/s0041-1345(96)00152-2. View

15.

Wingard J, Carter S, Walsh T, Kurtzberg J, Small T, Baden L . Randomized, double-blind trial of fluconazole versus voriconazole for prevention of invasive fungal infection after allogeneic hematopoietic cell transplantation. Blood. 2010; 116(24):5111-8. PMC: 3012532. DOI: 10.1182/blood-2010-02-268151. View

16.

Herbrecht R, Denning D, Patterson T, Bennett J, Greene R, Oestmann J . Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002; 347(6):408-15. DOI: 10.1056/NEJMoa020191. View

17.

Dolan C, Hall M, Blazes D, Norwood C . Pseudoporphyria as a result of voriconazole use: a case report. Int J Dermatol. 2004; 43(10):768-71. DOI: 10.1111/j.1365-4632.2004.02177.x. View

18.

Ibrahim S, Singer J, Arron S . Catastrophic squamous cell carcinoma in lung transplant patients treated with voriconazole. Dermatol Surg. 2010; 36(11):1752-5. PMC: 3046628. DOI: 10.1111/j.1524-4725.2010.01596.x. View

19.

Van Wauwe J, Coene M, Goossens J, Cools W, Monbaliu J . Effects of cytochrome P-450 inhibitors on the in vivo metabolism of all-trans-retinoic acid in rats. J Pharmacol Exp Ther. 1990; 252(1):365-9. View

20.

Tolland J, McKeown P, Corbett J . Voriconazole-induced pseudoporphyria. Photodermatol Photoimmunol Photomed. 2007; 23(1):29-31. DOI: 10.1111/j.1600-0781.2007.00263.x. View