Are Some Transplant Recipients Exposed to Voriconazole at Risk for Skin Cancer?
Posted: Wednesday, November 28, 2018
Although the association between the use of the antifungal medication voriconazole and the risk for skin cancer has been unclear, the findings of a systematic review and meta-analysis published in the Journal of the American Academy of Dermatology shed further light on the subject. Jiali Han, PhD, of the Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, and colleagues reported an increased risk for cutaneous squamous cell carcinoma associated with exposure to voriconazole in individuals who received a lung or hematopoietic cell transplant.
“Longer duration or higher dose of voriconazole was associated with increased risk of [squamous cell carcinoma],” the investigators reported. “However, there was no significant association between voriconazole exposure and risk of [basal cell carcinoma].”
Dr. Han and colleagues focused on 8 studies involving more than 3,700 individuals with a lung or hematopoietic cell transplant. Five of these studies were included in the meta-analysis on squamous cell carcinoma and two of these studies were featured in the meta-analysis on basal cell carcinoma.
The overall relative risk for squamous cell carcinoma associated with voriconazole use was 1.86. A higher risk for squamous cell carcinoma associated with voriconazole use in both lung and hematopoietic cell transplant recipients was noted in a subgroup analysis by transplantation type. As for risk for basal cell carcinoma, no association with voriconazole use was found; the overall relative risk for basal cell carcinoma was 0.84.
According to the investigators, their findings support the need for “regular dermatologic surveillance” in patients receiving voriconazole. They also suggest alternatives to voriconazole (eg, posaconazole) be considered, especially in patients who may already be at elevated risk for squamous cell carcinoma.