Kusuki, S., Hashii, Y., Yoshida, H., Takizawa, S., Sato, E., Tokimasa, S., . . . Ozono, K. (2009). Antifungal prophylaxis with micafungin in patients treated for childhood cancer. Pediatric Blood and Cancer, 53, 605–609.

The primary aim of this study was to determine if micafungin is an effective and safe antifungal prophylaxis to be used for neutropenic pediatric patients undergoing chemotherapy treatment or stem cell transplantation treatment for cancer.  

Patient records were reviewed for pediatric oncology patients who received micafungin via IV (3 mg/kg per day) while they were neutropenic from May 2006 to September 2008. A total of 40 children were included in a record review that encompassed 146 patient cycles of chemotherapy.

• The sample consisted of 40 patients.
• Ages ranged from 1–17 years old.
• Key disease characteristics included acute leukemia, non-Hodgkin lymphoma, and solid tumors.
• Although 40 patients were treated prophylactically with micafungin, 39 of them received chemotherapy or stem cell transplantation for their disease. One did not receive either chemotherapy or stem cell transplantation as treatment for their cancer.
   

A single-site setting.

• The phase of care was active treatment
• The application was pediatrics
   

 Retrospective

Development of probable, proven, or suspected invasive fungal infection.

Of the 40 records reviewed, a total of 131 patient cycles were noted for chemotherapy and 15 patient cycles for those undergoing stem cell transplantation. Thirty of 40 patients had successful prevention of invasive fungal infection. Only one patient developed a diagnosed fungal infection, the rest of the failures were suspected fungal infections.

Based on this study, it appears that micafungin may be a safe and effective prophylactic treatment for fungal infection in pediatric patients with cancer. A larger randomized study would be beneficial to prove the success rates in a larger randomized group.

•  The study had a small sample size (less than 100).
•  Invasive fungal infections are more prominent in hematologic malignancies as opposed to solid tumors, thus combining these two populations in a study may skew the results for positive benefit.
   

Micafungin is generally tolerated well with minor side effects and minimal drug-to-drug interactions as opposed to other treatment for fungal prophylaxis. More exclusive, randomized studies are needed to determine if it is appropriate for all patient populations and demographics.