Contrary to the case with
bacterial infections, progress in the diagnosis and treatment of
invasive mycoses in
cancer patients has been unsatisfactory.
Amphotericin B deoxycholate has remained the
drug of choice for severe
invasive fungal infections for nearly 40 years. However, its infusion-related side effects, as well as its toxicity, may at times lead to
dose reduction or early discontinuation of the treatment. The introduction of the new
triazoles,
fluconazole and
itraconazole, has improved the therapeutic chances against several
fungal infections; however, the need for a broad-spectrum
drug in empiric antifungal
therapy, the emergence of
fluconazole-resistant Candida species, and the limitations of
itraconazole in terms of speed action and erratic oral absorption represent important limitations. Recently, laboratory and clinical research has been directed at the development of new formulations of older classes of antifungals, the introduction of new classes of antifungals, and the use of
immunomodulation associated with antifungal
therapy. This paper reviews the more recent advances in the treatment of
fungal infections in
cancer patients.