Antifungal therapies for cancer
Antifungal therapies are a category of anti-infective medications designed to combat fungal infections, which can be particularly problematic for cancer patients due to their compromised immune systems. These therapies are essential for treating infections caused by fungi such as Aspergillus, Candida, and Cryptococcus, among others. Patients with certain types of leukemia, as well as those undergoing procedures like bone marrow or stem cell transplants, are at a higher risk for these infections, making antifungal treatments crucial for their care.
The antifungal agents encompass various subclasses, including polyene antibiotics, echinocandins, and synthetic triazoles, each with distinct mechanisms of action that target fungal cell structures and functions. These medications can be administered through multiple routes, including orally and intravenously, depending on the patient's needs. While effective, antifungal therapies can also lead to side effects such as abdominal pain, allergic reactions, and more severe effects like kidney and liver failure.
As of the mid-2020s, there have been advancements in antifungal drug development, focusing primarily on improving existing compounds, although there remains significant potential for discovering new treatments in the future. Understanding these therapies and their implications can be vital for patients, caregivers, and healthcare providers engaged in cancer treatment.
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Antifungal therapies for cancer
ATC CODE: J02
DEFINITION: Antifungal therapies form a class of anti-infective drugs that are effective against fungi such as Aspergillus, Candida, Cryptococcus, Fusarium, and Scedosporium apiospermum.
Cancers treated: Antifungal agents are used to treat fungal infections that develop in patients with any cancer. Fungal infections commonly occur in patients with acute lymphoblastic leukemia and acute myelocytic and monocytic leukemia. Antifungal agents also prevent fungal infections in patients who have undergone bone marrow or stem cell transplantation.
Subclasses of this group: Polyene antibiotics, echinocandins, bis-triazole derivatives, fluorinated pyrimidines, synthetic triazoles, imidazole derivatives, polyene macrolides
Delivery routes: Antifungal agents can be administered orally in capsules, tablets, or liquid suspension or vaginally by vaginal tablet. They can be administered in the hospital or at home. Some antifungal agents are administered by intravenous (IV) infusion while the patient is hospitalized. As the patient’s condition improves, IV infusions may be administered at home or in an outpatient treatment center.
How these drugs work: Polyene antibiotics bind to the fungal cell membrane components and alter the cell’s permeability, causing fungal cell death. Echinocandins work by inhibiting an essential enzyme in the fungal cell wall. Bis-triazole derivatives inhibit the fungal cytochrome P-450 and weaken the fungal cell wall, causing fungal cell death. Fluorinated pyrimidines interfere with protein synthesis within the fungal cells, causing cell death. Synthetic triazoles inhibit fungal cell wall synthesis, causing cell wall instability and, ultimately, cell death. Imidazole derivatives impede the formation of ergosterol, a sterol necessary for fungal cell-wall synthesis. Without ergosterol, the fungal cell wall becomes porous and unstable, causing cell death. Polyene macrolides bind to sterols, making the fungal cell wall permeable. This increased permeability allows intracellular components to leak from the fungal cell, causing fungal cell death.
Side effects: Side effects vary according to the antifungal agent. The amphotericans are potent antifungals with toxic side effects, including kidney and liver failure. There are a large number of potential side effects that may develop. These include, but are not limited to:
- Side effects that may occur with antifungal agents include:
- abdominal pain
- abnormal dreams
- allergic reaction
- sinusitis
- sore throat
In the mid-2020s, advances were made in antifungal drug compounds with new treatments in various stages of development. Nonetheless, rapid advances or breakthroughs had yet to occur. Most efforts were directed toward derivatives of existing drugs. Tremendous potential remained for additional research and development of new antifungal treatments.
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