Squamous cell carcinoma of the skin and voriconazole therapy in lung transplant recipients: A case series

• Published in: Journal of Pharmacy Practice and Research
• Main Author: Neoh C.F.; Snell G.I.; Levvey B.; Morrissey C.O.; Slavin M.A.; Stewart K.; Kong D.C.M.
• Format: Article
• Language: English
• Published: Society of Hospital Pharmacists of Australia 2017
• Online Access: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85018760115&doi=10.1002%2fjppr.1234&partnerID=40&md5=2d3b6fdf55b0446b5cc94f29e966909e

Background: Prolonged voriconazole therapy may be associated with skin squamous cell carcinoma (SCC) in lung transplant (LTx) patients. This is of concern given the frequent use of voriconazole in the LTx setting. The impact of voriconazole therapy on the risk of developing skin SCC in an Australian LTx cohort with additional risk due to high levels of sun exposure remains unclear. Aim: This study described the extent and outcomes of new or recurrent skin SCC among LTx patients receiving voriconazole. Methods: The present retrospective cohort study was undertaken at The Alfred Hospital, Australia. Adult LTx recipients with skin SCC who had received voriconazole between 1 July 2003 and 30 June 2010 were included. Medical records and histopathology reports were reviewed. Demographics, clinical characteristics, voriconazole exposure (dose and duration), potential risk factors for skin SCC and manifestations of the skin SCC were recorded. The Naranjo algorithm was used to determine the likelihood of skin SCC being due to voriconazole exposure. Results: Of the 102 LTx patients receiving voriconazole, 14 (13.7%) had at least one episode of skin SCC: seven (Group 1) had skin SCC during or after voriconazole exposure; three (Group 2) had skin SCC before commencing voriconazole therapy, which recurred or worsened subsequently; three (Group 3) had a history of skin SCC prior to voriconazole being prescribed but no skin SCC was noted during or after voriconazole exposure; and one (Group 4) had multiple skin SCCs before LTx and voriconazole use, and developed further skin SCC post voriconazole. The median (interquartile range) of voriconazole exposure in Group 1, 2 and 3 patients was 119 days (79.5, 693), 1127 days (665.5, 1129) and 173 days (135.5, 341), respectively. The Naranjo score indicated a probable association between voriconazole use and skin SCC in three patients and a possible relationship in eight. Conclusions: Prolonged voriconazole exposure may contribute to the development, recurrence and progression of skin SCC in LTx patients. © 2017 The Society of Hospital Pharmacists of Australia.