1. ¹Department of Infectious Diseases, Infection Control, and Employee Health, MD Anderson Cancer Center, Houston, TX, USA
2. ²Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
3. ³Department of Blood and Marrow Transplantation, MD Anderson Cancer Center, Houston, TX, USA

Correspondence: Dr A Safdar, Department of Infectious Diseases, Infection Control, and Employee Health, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. E-mail: asafdar@mdanderson.org

Received 24 July 2006; Revised 12 September 2006; Accepted 12 September 2006.

Abstract

Pneumocandins have concentration-dependent antifungal activity and higher dose of caspofungin (HD-CAP) in combination with other licensed antifungal therapy (OLAT) may improve response. Thirty-four patients who received HD-CAP were compared with 63 patients who received standard dose (SD)-CAP. There were no differences between the groups in either patient or disease characteristics. Significantly more patients in the HD-CAP arm had extrapulmonary infections (29 vs 8% in SD group; P=0.0053), and non-Aspergillus species infection (21 vs 6%; P=0.05) and had received prior antifungal therapy (71 vs 33%; P=0.0004). No serious adverse reactions were noted in patients receiving HD- or SD-CAP therapy. Twelve weeks after treatment commenced 44% had a complete or partial response compared with 29% in SD-CAP group (P=0.1). Logistic regression analysis showed a significant probability of a favorable outcome at 12 weeks in patients who received HD-CAP (OR 3.066, 95% CI, 1.092–8.61; P=0.033). This may in part reflect higher number of patients in HD group had received granulocyte–macrophage colony-stimulating factor (41 vs 14% in SD group; P=0.04) and/or interferon (26 vs 5% in SD group; P=0.003) immune enhancement. Further studies are needed to evaluate efficacy of HD-CAP in severely immunosuppressed cancer patients with invasive fungal infections.