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已发表论文
酪氨酸激酶抑制剂治疗期间侵袭性肺曲霉病的晚期骨肉瘤患者经治疗药物监测指导下的抗真菌治疗
Authors Wen R, Ni W, Gu X, Liu B, Bai G, Zhang X
Received 28 June 2025
Accepted for publication 21 December 2025
Published 26 December 2025 Volume 2025:18 Pages 6973—6978
DOI https://doi.org/10.2147/IDR.S545985
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Sara Mina
Ruiting Wen,1,* Wentao Ni,2,* Xiaotong Gu,1,3,* Boyu Liu,1 Gali Bai,1,4 Xiaohong Zhang1
1Department of Pharmacy, Peking University People’s Hospital, Beijing, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital, Beijing, People’s Republic of China; 3Department of Pharmacy, China Aerospace Science and Industry Corporation 731 Hospital, Beijing, People’s Republic of China; 4Department of Pharmaceutical Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xiaohong Zhang, Department of Pharmacy, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China, Email zhangxiaohong@pkuph.edu.cn Ruiting Wen, Department of Pharmacy, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China, Email tzwxm@bjmu.edu.cn
Abstract: Antifungal therapy for invasive pulmonary aspergillosis (IPA) can be challenging in cancer patients due to interpatient variability in pharmacokinetic properties of antifungals and potential drug-drug interactions (DDIs). This case report describes a 14-year-old boy with advanced osteosarcoma diagnosed with invasive pulmonary aspergillosis (IPA) after chemotherapy. Initial treatment of voriconazole showed poor improvement, as therapeutic drug monitoring (TDM) revealed exceptionally low trough concentration (0.28 μg/mL) even after dose increase. When voriconazole was switched to isavuconazole, favorable antifungal response was observed with isavuconazole trough concentrations ranging from 2.43 μg/mL to 4.12 μg/mL. Moreover, TDM also detected no obvious pharmacokinetic DDI between isavuconazole and apatinib but potential DDI between voriconazole and anlotinib in this patient. This case highlights the importance of individualized pharmacokinetic considerations in antifungal therapy in cancer patients. TDM may be a useful aid for therapeutic regimen decision and optimization.
Keywords: invasive pulmonary aspergillosis, voriconazole, isavuconazole, apatinib, pharmacokinetics
1Department of Pharmacy, Peking University People’s Hospital, Beijing, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital, Beijing, People’s Republic of China; 3Department of Pharmacy, China Aerospace Science and Industry Corporation 731 Hospital, Beijing, People’s Republic of China; 4Department of Pharmaceutical Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xiaohong Zhang, Department of Pharmacy, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China, Email zhangxiaohong@pkuph.edu.cn Ruiting Wen, Department of Pharmacy, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China, Email tzwxm@bjmu.edu.cn
Abstract: Antifungal therapy for invasive pulmonary aspergillosis (IPA) can be challenging in cancer patients due to interpatient variability in pharmacokinetic properties of antifungals and potential drug-drug interactions (DDIs). This case report describes a 14-year-old boy with advanced osteosarcoma diagnosed with invasive pulmonary aspergillosis (IPA) after chemotherapy. Initial treatment of voriconazole showed poor improvement, as therapeutic drug monitoring (TDM) revealed exceptionally low trough concentration (0.28 μg/mL) even after dose increase. When voriconazole was switched to isavuconazole, favorable antifungal response was observed with isavuconazole trough concentrations ranging from 2.43 μg/mL to 4.12 μg/mL. Moreover, TDM also detected no obvious pharmacokinetic DDI between isavuconazole and apatinib but potential DDI between voriconazole and anlotinib in this patient. This case highlights the importance of individualized pharmacokinetic considerations in antifungal therapy in cancer patients. TDM may be a useful aid for therapeutic regimen decision and optimization.
Keywords: invasive pulmonary aspergillosis, voriconazole, isavuconazole, apatinib, pharmacokinetics