Karl Potnik, 52, is a mushroom fancier who'll eagerly
explain the difference between morels and boletes, but
he's not so fond of other fungi, particularly the infection
his chemotherapy-compromised immune system has been unsuccessfully
fighting off. Help is on the way for people like Karl
as a report in the September 30 issue of the New England
Journal of Medicine details how caspofungin is just
as effective as the gold standard liposomal amphotericin
B in treating fungal infections in cancer patients. As
a bonus, caspofungin is easier for patients to tolerate.
Echinocandins, like caspofungin,
zap fungi by blocking the manufacture of a vital component
of the fungal cell wall. Its prowess against Candida
and Aspergillus species has led to US and Canadian
approval of other echinocandins for fungal infections
that seem to shrug off less effective treatments.
The trial, headed by Dr Thomas
Walsh of the National Cancer Institute in Bethesda,
Maryland, included 1,095 patients who were stratified
according to risk and whether they were veterans of
antifungal drug treatments. They were then given either
caspofungin or liposomal amphotericin B.
Treatment success was realized
in 33.9% of the 556 caspofungin patients and 33.7% of
the 539 liposomal amphotericin B recipients. Moreover,
caspofungin produced fewer side effects even as it matched
amphotericin's antifungal power. Only 2.6% of the caspofungin
group had kidney damage, as compared to 11.5% of the
other group.
The results offer the potential
of a "new molecular strategy to hit these organisms,"
said Dr Walsh to HealthDailyNews. "Our approach is to
try to treat earlier rather than later, a preventative
strategy for patients at high risk."
This approach could help minimize
the toll exacted by fungal infections on immunocompromised
cancer patients. The cancer-fighting chemotherapy and
bone marrow transplant regimens deplete a body's immune
defences. When faced with bacterial assault, antibiotics
can be protective. But, of course, not against fungi,
whose resulting infections in cancer "have emerged in
the last decade as particularly devastating complications,"
according to Dr Walsh.
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