Low dose liposomal Amphotericin B therapy of pulmonary fungal infections in immunocompromised thoracic cancer patients

Cosimo Lequaglie, G. Giudice, P. P. Brega Massone

Research output: Contribution to journalArticle

Abstract

Purpose: Incorporation of Amphotericin B into liposomes reduces the drug's cytotoxicity in immunocompromised cancer patients, but does not diminuish the antifungal activity. Methods: Experimental therapy low dose Ampothericin B of pulmonary fungal infections in 12 immunocompromised patients with thoracic tumors, hospitalised in the Istituto Nazionale Tumori, Milano, is reported. All patients were treated with fluconazole waiting for mycological response. Seven cases had invasive aspergillosis and five deep candidosis. The infection was revealed by BAL, blood culture, and CT scan of chest. After mycological response we administered liposomal Amphotericin B (AmBisome), because the previous therapy failed. The administration protocol of Ambisome was: from 1 to 2.2 mg/kg/die iv for 10 days. The maximum daily dose was 100 mg. Results: In all cases the choice of antifungal therapy did not cause serious side effects, due iv administration, like thrombophlebitis, or nephrotoxicity or hepatic disfunction. We obtained fungal sterilization in 10 days versus 20 and more of conventional treatment. After 8-06 months, 10 patients were alive: no mycotic relapses or reinfections were detected. Two patients died, respectively 25 and 28 days after the start of AmBisome therapy for ARDS and for progression of cancer. Conclusions: In a subset of critically ill patients with thoracic malignancies, low-dose liposomal Amphotericin B (AmBisome) resulted in complete eradication of pulmonary Aspergillus and Candida infections and was remarkably well tolerated.

Original languageEnglish
JournalChest
Volume114
Issue number4 SUPPL.
Publication statusPublished - Oct 1998

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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