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NCCN Trends™ Highlights: Fungal Infections in Immunocompromised Patients

Sherry L. Ulrich. MBA, Market Insights Specialist, NCCN

Despite the availability of a number of antifungal drugs, invasive fungal infections (IFIs) can be a challenge for the immunocompromised, particularly patients with hematologic malignancies who may develop neutropenia as a complication of chemotherapy, as well as transplant patients.i, ii, iii Because some types of infections are not reportable in the United States, it is difficult to pinpoint the number of cases.  However, due to newer immunosuppressive drugs as well as the increase in transplant recipients, it is likely that the incidence rate for invasive aspergillosis (IA) and mucormycosis increased as well.iv 

Although IA is uncommon, it is estimated that this serious infection’s mortality rate ranges from 40 – 80 percent in immunocompromised patients who have widespread infection, according to the Infectious Disease Society of America Guidelines.v,vi  Moreover, for patients with a delayed or missed diagnosis of IA, fatality is nearly 100 percent.i   

Mucormycosis is rare, but frequently life-threatening.iv  Mortality rates range from 40 – 70 percent, depending on a patient’s underlying conditions, such as diabetes, keto-acidosis, and others, as well as level of risk.v,vii

NCCN Trends Survey & Data

In September 2015, the National Comprehensive Cancer Network® (NCCN®) conducted an NCCN Trends™ survey about treatment of fungal infections in patients with cancer. 

NCCN Trends™ is a survey-based analytics tool from NCCN that focuses on how clinicians in the United States and abroad deliver cancer care, including, but not limited to patterns of care and awareness and utilization of various treatment modalities. Data is gathered through electronic surveys.

More than 500 global health care providers responded to the survey—primarily physicians, surgeons, and oncologists. When asked which therapeutic agent they use first to treat patients with known or suspected IA, 50 percent of respondents said they would use voriconazole, while 32 percent said they would use amphotericin B as the first therapeutic agent.

Survey participants were also asked which therapeutic agent they would use first to treat patients with known or suspected invasive mucormycosis.  Fifty-five percent of respondents selected amphotericin B, with voriconazole as the second most selected agent at 24 percent. 

The results of the survey illustrate concordance with the recommendations included in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prevention and Treatment of Cancer-Related Infections, Version 2.2016.  For treatment of IA, the NCCN Guidelines® for Prevention and Treatment of Cancer-Related Infections recommend voriconazole as standard of care, with a category 1 rating, noting that it has poor activity against mucormycosis.  The NCCN Guidelines also recommend caspofungin, which is active against IA, but not effective against other fungal pathogens. Furthermore, according to the Guidelines, amphotericin B formulations have antifungal activity including mucormycosis.viii  Although data are emerging for clinical activity on the newer antifungal agents like isavuconazole and posaconazole for patients with fungal infections, currently it is limited, which may be why less respondents have utilized them.

About NCCN Trends Surveys & Data

NCCN Trends is a survey-based analytics tool from NCCN that focuses on how clinicians in the United States and abroad deliver cancer care. NCCN Trends Surveys pose questions regarding topics including, but not limited to, patterns of care and awareness and utilization of various treatment modalities, as well as key topics impacting oncology stakeholders, such as how changes in the health care environment impact them and their patients.

Data is gathered through brief electronic surveys to more than 186,000 health care providers who access NCCN.org on a frequent basis and express interest in responding to NCCN Trends Surveys. These clinicians consist of practicing physicians in diverse practice settings, including academic/research cancer centers, community hospitals, and private practices. Survey participants also represent pharmacists, nurses, and other oncology stakeholders.

NCCN TrendsSurveys and Data are independent of any NCCN Guidelines or other NCCN clinical recommendations.

To participate in future NCCN Trends™ surveys, please update your NCCN registration profile at https://www.nccn.org/store/Profile/Profile.aspx and select the option to receive NCCN Trends™ communications.

If you would like to sponsor an NCCN Trends™ survey in the future, please contact Sherry Ulrich at Ulrich@nccn.org.

 

Additional Resources:

On September 30 – October 1, 2016, NCCN will host its 11th Annual Congress: Hematologic Malignancies in New York, NY.

The treatment of hematologic malignancies is increasingly complex. Issues relating to pathology, transplantation, and various new therapies require oncologists and hematologists to stay abreast of breakthrough advances. In addition, targeted therapies and oral treatments bring the latest benefits to patients. This congress focuses on the new approaches that have been incorporated into patient management, including the use of drugs, biologics, and diagnostics.

This year's Congress will kick off with registration, exhibits, and refreshments on Friday, September 30th at 4:30 PM, followed by educational sessions starting at 6:00 PM. The Congress will end at 5:00 PM on Saturday, October 1st.

For additional information and to register, please visit: https://www.nccn.org/HEM


[i] Brown GD, Denning DW, Gow NAR, et al. Science Translational Medicine.org. Hidden Killers: Human Fungal Infections. 2012;4(165):1-9.

[ii] Low CY, Rotstein C. F1000 Medicine Reports. Emerging fungal infections in immunocompromised patients. 2011. http://f1000.com/reports/m/3/14

[iii] Gedik H, Simsek F, et al. Therapeutics and Clinical Risk Management. Primary or secondary antifungal prophylaxis in patients with hematological malignancies: efficacy and damage. 2014;10:305-312.

[iv] http://www.cdc.gov/fungal/diseases/aspergillosis/statistics.html. http://www.cdc.gov/fungal/diseases/mucormycosis/statistics.html. Accessed July 21, 2016.

[v] Oren I, Paul M. Clinical Microbiology and Infection. Up to date epidemiology, diagnosis and management of invasive fungal infections. 2014;20(6):1-4.

[vi] Ogle K. Clinical Oncology News. Hematologic Malignancies: Early Diagnosis Vital To Defeating Invasive Aspergillosis. 2016. www.clinicaloncology.com/Article/PrintArticle?articleID=37122

[vii] http://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/drugs/anti-infectivedrugsadvisorycommittee/ucm430748.pdf Accessed July 21, 2016.

[viii]Baden, Lindsey R., MD, et. al., NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prevention and Treatment of Cancer-Related Infections, Version 2.2016. © 2016 National Comprehensive Cancer Network, Inc.  Available at NCCN.org. Accessed: July 22, 2016.