Efficacy and Tolerability of Micafungin Monotherapy for Candidemia and Deep-Seated Candidiasis in Adults with Cancer

The response rate among 58 patients with cancer and candidemia or deep-seated candidiasis treated with micafungin mono-therapy was 81%. Intensive care unit (ICU) stay, concomitant nonfungal infections, and acute kidney injury were significantly associated with the 30-day crude mortality rate. Severe neutropenia was an independent predictor of micafungin failure. The efficacy and safety of micafungin in cancer patients with invasive candidiasis were comparable to those reported for patients without malignancy and for cancer patients treated with caspofungin. The shift to non-albicans Candida species over the past 2 de-cades is a worrisome trend, as these species frequently exhibit decreased susceptibility to azoles, justifying the use of echinocan-dins in first-line empirical treatment of invasive candidiasis (1–3). Micafungin is a well-tolerated echinocandin that met noninferi-ority criteria in two randomized trials in comparison with lipo-somal amphotericin B (4) and caspofungin (5). In a subgroup analysis of candidiasis in cancer patients, response rates for treat-ment with micafungin were lower in neutropenic patients than in nonneutropenic patients, but themajority of patients experienced successful treatment of their infections (6). Patients enrolled in controlled studies make up only a small proportion of those seen in routine clinical practice in individual institutions, especially cancer hospitals (7). Therefore, assessing the real-world safety and efficacy of antifungals in populations of immunosuppressed patients with malignancies is important. To that end, we retrospectively studied the efficacy and tolerability of monotherapy with micafungin for candidemia and deep-seated candidiasis at a single tertiary cancer center, and we identified predictors of responses to micafungin treatment and all-cause-related death. Pharmacy databases were searched for adult patients (18 years of age) with the indication of candidemia or invasive candi-diasis who received at least three consecutive doses of micafungi