NEW YORK (Reuters Health) - Recipients of lung transplants (LT) or hematopoietic cell transplants (HCT) who are taking the antifungal voriconazole may be at increased risk of squamous cell carcinoma (SCC), researchers report.
"Our systematic review and meta-analysis of 8 observational studies suggested a significant association between voriconazole use and increased risk of SCC among individuals who have undergone LT or HCT," they write in the Journal of the American Academy of Dermatology, online August 18.
"Long-term use of voriconazole was especially associated with increased risk of cutaneous SCC in these patients," senior author Dr. Jiali Han of the Melvin and Bren Simon Cancer Center of Indiana University in Indianapolis told Reuters Health by email.
Dr. Han and his colleagues searched PubMed and Embase and found eight studies involving 3,710 patients who had undergone LT or HCT.
To account for heterogeneity between studies, the authors used a random-effects model to calculate the pooled relative risk (RR) for the association between voriconazole exposure and risk of SCC or basal cell carcinoma.
Voriconazole was significantly linked with elevated risk of SCC (RR, 1.86), regardless of type of transplantation or sun exposure; and the longer patients were treated with the drug, the more their SCC risk increased (RR, 1.72).
Use of the drug was not linked with a higher risk of basal cell carcinoma, however (RR, 0.84).
"Voriconazole is known as a photosensitizing agent and may induce phototoxicity by interacting with ultraviolet light," Dr. Han explained.
"Transplant patients at high risk of SCC may require long-term voriconazole use to manage or prevent fungal infections. These findings suggest the need for regular dermatologic monitoring of patients taking voriconazole, or treating them with alternative medications, especially in patients already at high risk of developing SCC," he advised.
Dr. Han acknowledged that lack of data and heterogeneity of retrospective observational studies limited their analysis, and he recommends further related research to confirm these results.
Dr. Kelly C. Nelson, a clinical associate professor in the department of dermatology at The University of Texas MD Anderson Cancer Center in Houston, told Reuters Health by email, "Dermatologists are comfortable with the interplay between anti-rejection medication selection and squamous cell carcinoma risk for solid organ transplant patients, particularly patients who have received cardiac and renal transplants."
"However," added Dr. Nelson, who was not involved in the study, "this study presents the correlation between voriconazole use and squamous cell carcinoma risk for stem cell transplant patients, which has not been a reflexive association for many of us who specialize in the care of cancer patients."
"This study also highlights a dermatologist's opportunity to potentially engage a patient's medical oncologist or infectious disease physician to raise the possibility of transitioning to an alternative antifungal therapy for transplant patients who note an uptick in cutaneous squamous cell carcinomas after starting voriconazole therapy," she said.
Dr. Shawn Demehri, director of the High Risk Skin Cancer Clinic at Massachusetts General Hospital in Boston, told Reuters Health by email, "Many transplant patients receive voriconazole to prevent fungal infection. It is important to note the skin cancer risk associated with this medication and to use this drug with caution in high-risk patients who have sun-damaged skin and previous history of skin cancer."
"These findings will provide evidence for the cautious use of voriconazole in patients at high risk of developing skin cancer and will also highlight the need for closer dermatological monitoring of patients who are on voriconazole to detect and treat any skin malignancy early to avoid complications," noted Dr. Demehri, who also was not involved in the study.
The study did not have outside funding.
SOURCE: https://bit.ly/2PAatjQ
J Am Acad Dermatol 2018.
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