Antifungal Drug Linked to Skin Cancer in Lung Transplant Recipients

Health care providers urged to counsel lung transplant recipients on the risks connected with skin cancer, light protection, and routine screening.

Voriconazole, used to treat fungal infections in lung transplant recipients, has been reported to increase their risk of skin cancer and mortality.

Because transplant recipients require more intensive immunosuppression therapy they are more likely to develop cutaneous squamous cell carcinoma (SCC) — 65 times more likely than the general population. Transplant recipients are also more susceptible to fungal infections caused by the Aspergillus fungi, which could potentially lead to aspergillosis.

Experts urge health care providers to thoroughly counsel lung transplant recipients on the risks connected with skin cancer, light protection, and routine screening.

In the study published in the American Journal of Transplantation, researchers examined the cases of all 455 single-lung, double-lung, and heart-lung transplant recipients at UCSF between October 1991 and December 2012. The research team noted which patients had been exposed to voriconazole — they wanted to assess how the drug affected SCC, Aspergillus colonization, aspergillosis, and all-cause mortality.

The study results indicated that risk for SCC significantly increased by 73% when patients were exposed to voriconazole (the risk increase directly paralleled the length of drug exposure).

Researchers noted that the drug exposure did not reduce the risk of aspergillosis, but it did reduce all-cause mortality.

“It is important for physicians to be aware of the impact of voriconazole on these outcomes,” said Sarah Arron, MD, associate professor of dermatology and director of the University of California-San Francisco (UCSF) High Risk Skin Cancer Clinic.

Arron continued, “Lung transplant programs should also consider patient-specific risk factors when deciding on the type, dose, and duration of antifungal prophylaxis regimens.”