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DOI: 10.1055/s-2005-836502
© Georg Thieme Verlag Stuttgart · New York
New Antifungal Drugs and the Pediatric Cancer Patient: Current Status of Clinical Development
Neue Antimykotika für die Pädiatrische Hämatologie/Onkologie: Stand der klinischen EntwicklungPublication History
Publication Date:
27 April 2005 (online)
Abstract
Invasive mycoses are important causes for treatment related morbidity and mortality in severely immunocompromised pediatric patients with hematological malignancies or hematopoietic stem cell transplantation. The past decade has witnessed a major expansion of antifungal drug research, which has resulted in the development of the novel class of echinocandin lipopeptides (anidulafungin, micafungin, caspofungin) and a new generation of antifungal triazoles with improved pharmacological properties (posaconazole, ravuconazole, voriconazole). Whereas caspofungin and voriconazole have been licensed in the European Union, the United States, Canada and several other countries throughout the world, posaconazole, ravuconazole, anidulafungin and micafungin are under regulatory review or in advanced stages of clinical development. Caspofungin and voriconazole are increasingly prescribed in pediatric patients, although pediatric dosage finding and safety evaluations have not been completed. This article reviews the clinical pharmacology of the new antifungal agents and the status of their clinical development in immunocompromised pediatric patients.
Zusammenfassung
Invasive Pilzinfektionen sind wichtige Ursachen von Morbidität und Mortalität bei der Behandlung abwehrgeschwächter Kinder und Jugendlicher mit hämatologischen Neoplasien oder hämatopoetischer Stammzell-Transplantation. Das vergangene Jahrzehnt hat eine intensivierte Forschung auf dem Gebiet der antimykotischen Chemotherapie erlebt, die zu der Entwicklung der neuen Substanzklasse der Echinocandine (Anidulafungin, Micafungin, Caspofungin) und einer neuen Generation von antimykotischen Triazolen mit verbesserten pharmakologischen Eigenschaften (Posaconazol, Ravuconazol, Voriconazol) geführt hat. Während Caspofungin und Voriconazol in der Europäischen Union, den Vereinigten Staaten, Kanada und mehreren anderen Ländern zugelassen ist, befinden sich Posaconazol, Ravuconazol, Anidulafungin und Micafungin in Evaluation durch die Zulassungsbehörden bzw. in fortgeschrittenen Stadien der klinischen Entwicklung. Caspofungin und Voriconazole werden zunehmend bei pädiatrische Patienten eingesetzt, obwohl Dosisfindung und Prüfung von Sicherheit und Verträglichkeit in dieser Population nicht abgeschlossen sind. Die vorliegende Arbeit gibt eine Übersicht über die klinische Pharmakologie der neuen antimykotischen Substanzen und über den derzeitigen Stand ihrer klinischen Entwicklung bei abwehrgeschwächten Kindern und Jugendlichen.
Key words
antifungal agents - voriconazole - caspofungin - mycoses - cancer - children
Schlüsselwörter
Antimykotika - Voriconazol - Caspofungin - Pilzinfektionen - Krebs - Kinder
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Andreas H. GrollM. D.
Infectious Disease Research Program · Department of Pediatric Hematology and Oncology · University Children's Hospital
Albert-Schweitzer-Strasse 33
48129 Muenster
Germany
Phone: +49/2 51/8 35 28 01
Fax: +49/2 51/8 35 28 04
Email: grollan@mednet.uni-muenster.de