Dear XXXXXXXXX:
Alas the renewal of spring is here and with it many new and exciting things for doctorfungus.
Currently in the works is a CME module that we'll provide the Mycology community with cutting edge programs that you can take from the comfort of your home.
Our first program, slated to be released in June 2002, is a leading-edge program entitled "Opportunistic Fungi in the Immunocompromised Patient", directed by Dr. David Greenberg and brought to you by the International Immunocompromised Host Society. Stay tuned!
Also have a look at our new and improved slide bank, renamed Lecture Bank. The doctorfungus lecture bank is your on-line resource for sharing and exchanging your power point slides. Why not have a look and contribute your favorite lecture today.
John Rex, Mike McGinnis &
the entire doctorfungus team
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| UPCOMING EVENTS |
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| USEFUL SITES |
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Voriconazole and Caspofungin: New alternatives for the treatment of Invasive aspergillosis
Invasive aspergillosis (IA) has long been the scourge of seriously immunocompromised patients (Grow WB et al. Bone Marrow Transplant 2002;29:15-19). Therapeutic options to date have been limited to the amphotericin B preparations and itraconazole. These choices have never been entirely satisfactory due to problems with toxicity, limitations on methods of delivery, or unpredictable pharmacology. The past year has seen two new significant additions to our range of options for therapy of this difficult and life-threatening disease.
- VORICONAZOLE, a new choice for initial therapy of aspergillosis
First, voriconazole has now emerged as a significant new choice for therapy of aspergillosis. During the December 2001 ICAAC meeting in Chicago, Herbrecht et al. presented the results of the largest trial reported to date of primary therapy of invasive aspergillosis (Herbrecht R et al. 41st Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, IL, 2001, Abstract No. J-680). In this prospective, randomized, open-label study, patients were randomized to initial therapy with either voriconazole or amphotericin B deoxycholate. Outcome was assessed after 12 weeks. Changes of therapy to other licensed antifungal agents were permitted based on the patient's clinical response and ability to tolerate initial therapy, but outcomes at 12 weeks were grouped based on initial therapy. As can be seen in the following table, voriconazole produced both better responses and reduced mortality:
Initial randomized therapy
(number of patients) |
Voriconazole
(144) |
Amphoterin B
(133) |
Underlying Diseases
Allo BMT (%)
Auto BMT and HD (%)
Others |
26
56
18 |
23
63
14 |
Type of IA
Pulmonary (%)
Disseminated (%)
CNS (%) |
83
8.3
1.4 |
84
7.5
0.8 |
Response
CR/PR at 12 week
Survival |
52.8
70.8 |
31.6
57.9 |
CR/PR: Complete response/Partial Response; HD: Hematologic disease
In support of these data, the results of an open-label experience with voriconazole have also recently been published (Denning DW et al. Clin Infect Dis 2002;34:563-571.). 116 patients were enrolled either with proven (41%) or probable IA. Voriconazole was the primary therapy in half of these cases while the rest of them had previously failed amphotericin B deoxycholate, a lipid formulation of amphotericin B, or itraconazole. Overall, 48% of patients responded to therapy and 31% failed.
- CASPOFUNGIN, a new choice for salvage therapy
Second, the echinocandin antifungal agent caspofungin has also emerged as a valuable tool for patients with refractory aspergillosis. Based on an open-label series of patients with well studied and characterized invasive aspergillosis (Hiemenz J et al. Focus on Fungal Infections 11. Washington, DC, 2001, Abstract No. 21 and Maertens J et al. 40th Interscience Conference on Antimicrobial Agents and Chemotherapy. Toronto, CA, 2000, Abstract No. 1103), the US FDA approved the use of this agent in patients with invasive aspergillosis refractory to or intolerant to other agents ( http://www.fda.gov/cder/approval/index.htm). Although the results of open-label studies are always a bit difficult to interpret, responses were seen in this series in patients receiving corticosteroids, patients receiving tacrolimus or mycophenolate, patients who had progression of their underlying disease on therapy, patients who received chemotherapy during the study, and patients who were neutropenic. In some patients, there was also evidence of response prior to neutrophil recovery.
- Where next?
But, these studies generate as many questions as they answer. Due to regulatory constraints, the voriconazole study used amphotericin B deoxycholate as its comparator. One wonders how a lipid amphotericin B would have fared. The echinocandins appear useful as salvage therapy, but a great deal of attention has recently been focused on their potential role in combination therapy. For aspergillosis, this may be their most effective role. Stay tuned!
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Name that Fungus!
At doctorfungus.org we have detailed data on approximately 80 fungal genera. You can view them here. In addition, our genus-species database provides nomenclature information on more than 1400 species from almost 400 genera. You can access this part of the website here
Got a Link?
Doctorfungus has over 100 links to various on-line resources that we considered potentially useful to you. Are there any that we missed? Do you have one that you believe we should add?
See our list of on-line resources here, and let us know what you'd like us to add!
Quick Quiz!
Which species name has been associated with the most different genera? Give up? Find the answer here.
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doctorfungus's Mycology Resources |
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This extensive collection of downloadable images searchable by numerous criteria is every mycologist's dream come true!
>>Check it out<< | |
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The purpose of the doctorfungus lecture bank is to give you and your colleagues a repository for sharing, exchanging and collaborating on medical/scientific mycology-related pre-formatted PowerPoint slides.
>>Check it out<< | |
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A detailed susceptibility database that provides a way to search selected data from many different papers.
>>Check it out<< | |
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To sort out all those crazy fungal names, we've created this index. It currently contains data on ~1,000 species from ~400 different genera!
>>Check it out<< | |
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Keep yourself and your colleagues up-to-date on upcoming industry events with the doctorfungus mycological events calendar. You can even post events that we may have missed.
>>Check it out<< | | |
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