Clinical efficacy of caspofungin in the treatment of invasive aspergillosis.

Abstract

Caspofungin, the main representative of the echinocandin family has undergone a clinical experience that covers gradually the whole spectrum of the standard care of invasive aspergillosis (IA). Caspofungin salvage therapy in cases of previous therapy refractoriness or intolerance resulted in a 45% response rate. Empiric therapy with caspofungin compared with L-AMB in neutropenic patients with persisting fever showed an overall response rate of approximately 34%, with less toxicity for caspofungin. Combination therapy of caspofungin with other antifungal drugs has been studied mainly retrospectively in open non randomized trials and in one prospective non comparative small study showing an encouraging response rate of 55% as salvage combined treatment. The clinical experience with caspofungin as first-line therapy in IA is limited to 32 patients with an overall response rate of 56%. Caspofungin is well tolerated with very few histamine-release reactions and a good toxicity profile.