Efficacy and safety of micafungin for treatment of serious Candida infections in patients with or without malignant disease

The aim of this study was to evaluate micafungin efficacy for treatment of invasive candidiasis /candidaemia in patients with cancer. Modified intent-to-treat populations were analysed from two trials: one, in adults and children with confirmed Candida infection, compared micafungin (adults 100 mg day(-1); children 2 mg kg(-1) day(-1)) with liposomal amphotericin B (L-AmB 3 mg kg(-1) day(-1)); and the other, in adults only, compared micafungin (100 or 150 mg day(-1)) with caspofungin (50 mg day(-1); 70 mg loading dose). Primary efficacy endpoint in both trials was treatment success, defined as both clinical and mycological response at end of therapy. In the micafungin /L-AmB trial, 183 /489 patients had malignancy (37% neutropenic). In the micafungin /caspofungin trial, 176 /572 patients had malignancy (26% neutropenic). Micafungin treatment success rates were generally similar in patients with /without malignancy and to rates observed with L-AmB and caspofungin. Most patients with malignancy and neutropenia were successfully treated by all three drugs. For all drugs, incidence of discontinuations because of treatment-related adverse events was similar for patients with malignancy (<= 7.7%) vs. no malignancy (<= 8.0%). These results suggest that compared with L-AmB and caspofungin, micafungin was effective and well tolerated in patients with candidiasis /candidaemia with /without malignancy. Further prospective trials are recommended to evaluate comparative outcomes with a primary focus on patients with malignancies and invasive candidiasis.