Voriconazole Treatment Effect on Pediatric Patients: Retrospective Analysis

the Cancer Therapy Advisor take:

It is established that the use of voriconazole as an antifungal agent is associated with an increased risk of a number of cutaneous reactions such as skin cancer, phototoxicity, and accelerated photo-aging in adults.

Researchers sought to identify the risk for these adverse reactions in children, as those factors have not yet been clearly established. The researchers conducted a retrospective analysis of 430 pediatric patients from Boston Children’s Hospital who had received voriconazole between 2003 and 2013.

The researchers found that 20% of all children who received voriconazole displayed phototoxicity and 47% of children who received voriconazole for 6 months or longer experienced phototoxicity. The researchers also determined that cystic fibrosis, cumulative dose, cumulative treatment time, and white race were associated with phototoxicity.

In all patients analyzed, four experienced nonmelanoma skin cancer.  In patients who experienced phototoxicity, 5% discontinued their voriconazole treatment, 6% were referred to a dermatologist, and 26% were counseled by their primary physician regarding sun protection.

The research results are limited in that the design of the study is retrospective and there is a potential for referral bias given the fact that the study was limited to a single center. Based on their findings, the researchers concluded that photoxicity in children who were treated with voriconazole is relatively common and has the potential to lead to nonmelanoma skin cancer.