Adapted from Pappas et al. Clin Infect Dis. 2004;38:161–189.9
- Empirical therapy for presumed fungal infections in febrile, neutropenic patients.
- Treatment of candidemia and the following Candida infections: intraabdominal abscesses, peritonitis, and pleural space infections. CANCIDAS has not been studied in endocarditis, osteomyelitis, or meningitis due to Candida.
- Treatment of esophageal candidiasis.
- Treatment of invasive aspergillosis in patients who are refractory to or intolerant of other therapies (ie, amphotericin B, lipid formulations of amphotericin B, and/or itraconazole). CANCIDAS has not been studied as initial therapy for invasive aspergillosis.
The efficacy and safety of CANCIDAS has not been adequately studied in prospective clinical trials involving neonates and infants under 3 months of age.
Selected Information from the IDSA Guidelines for Treatment of Candidiasis9
Candida Bloodstream Infections Are Increasingly Frequent
- Bloodstream infections involving Candida are becoming more common and are often clinically associated with sepsis syndrome and high attributable mortality.
- Non-albicans species of Candida are becoming increasingly associated with invasive candidiasis.
- In 1 study, candidemia extended hospitalization stays by 22 days and increased costs by $34,000 to $44,000.
Susceptibility Testing Is Not Yet the Standard of Care
- Meaningful data do not exist for newer expanded-spectrum triazoles and echinocandins.
- Minimum inhibitory concentration (MIC) data for these compounds are available for all major Candida species, but interpretation of these MICs is undefined—particularly for echinocandins.
- Data relating to issues of resistance are most compelling for fluconazole. The greatest concern is with C glabrata, in which resistance rates are reported to be as high as 15%.
Efficacy of Empirical Antifungal Therapy Is Increasingly Important for Neutropenic Patients
- Empirical antifungal treatment decreases the occurrence of clinically overt invasive fungal infection.
- An approximate 20% risk of developing an overt invasive fungal infection exists in patients with neutropenia who have persistent fever despite receiving broad-spectrum antimicrobial treatment.
- Fluconazole may not be an appropriate choice because of its previous exposure and limited spectrum.
See more about the Epidemiology of Candida.
References
CANCIDAS is contraindicated in patients with hypersensitivity to any component of this product.
Concomitant use of CANCIDAS with cyclosporine should be limited to patients for whom the potential benefit outweighs the potential risk of increased hepatic enzyme abnormalities. See the Warning in the Prescribing Information. Patients who develop abnormal liver function tests during concomitant therapy should be monitored and the risk/benefit of continuing therapy should be evaluated.
Laboratory abnormalities in liver function tests have been seen in healthy volunteers and patients treated with CANCIDAS. In some patients with serious underlying conditions who were receiving multiple concomitant medications with CANCIDAS, isolated cases of clinically significant hepatic dysfunction, hepatitis, and hepatic failure have been reported; a causal relationship to CANCIDAS has not been established. Patients who develop abnormal liver function tests during therapy with CANCIDAS should be monitored for evidence of worsening hepatic function and evaluated for risk/benefit of continuing therapy with CANCIDAS.
For patients receiving CANCIDAS and tacrolimus, standard monitoring of tacrolimus blood concentrations and appropriate tacrolimus dosage adjustments are recommended.
Adult patients on rifampin should receive 70 mg of CANCIDAS daily. When CANCIDAS is co-administered to adult patients with inducers of drug clearance, such as efavirenz, nevirapine, phenytoin, dexamethasone, or carbamazepine, use of a daily dose of 70 mg of CANCIDAS should be considered.
When CANCIDAS is co-administered to pediatric patients with inducers of drug clearance, such as rifampin, efavirenz, nevirapine, phenytoin, dexamethasone, or carbamazepine, a dose of 70 mg/m2 daily (not to exceed an actual daily dose of 70 mg) should be considered.
Possible histamine-mediated symptoms have been reported including rash, facial swelling, pruritus, sensation of warmth, or bronchospasm. Anaphylaxis has been reported during administration of CANCIDAS.
The most common adverse reactions in adult patients treated with CANCIDAS (≥10%), regardless of causality, are: diarrhea, pyrexia, chills, ALT/AST increase, blood alkaline phosphatase increase, and decrease of blood potassium.
The most common adverse reactions in pediatric patients treated with CANCIDAS, regardless of causality, were pyrexia (29.2%), blood potassium decreased (15.2%), diarrhea (14%), increased aspartate aminotransferase (11.7%), rash (11.7%), increased alanine aminotransferase (11.1%), hypotension (11.1%), and chills (11.1%).
There is no clinical experience in adult patients with severe hepatic insufficiency (Child-Pugh score >9) and in pediatric patients with any degree of hepatic insufficiency.
Administer by slow intravenous infusion (IV) over approximately 1 hour. Not for IV bolus administration.
Before prescribing CANCIDAS, please read the Prescribing Information.
