ABSTRACT

The spectrum of invasive fungal disease has changed considerably in the past two decade. Since late 1980’s triazole prophylaxis has resulted in a significant decline in cases of invasive candidiasis among patients undergoing hematopoietic stem cell transplantation and those with acute leukemia. Recently, reduced rates of invasive mold disease following echinocandin and anti-mold triazoles use during the high risk periods have ushered optimism. This trend in effective drug-mediated prevention has not been without set backs including unexpected toxicity due to drug-drug interaction, and difficult-to-treat breakthrough fungal disease due to previously uncommon yeasts and filamentous fungi. The rise in virulent non-albicans Candida species and non-Aspergillus molds has, to some extent compromise the recent advances in early diagnosis and effective antifungal therapy. As the understanding of hosts’ genetic (polymorphisms) vulnerability to fungal disease improves, next generation of diagnostic assays (DNA proliferation, microarray and other technologies) gain clinical validation, approach towards mitigating underlying immune defects with recombinant cytokines, strategies to restore innate and adaptive immune dysfunction become feasible, and target-specific effective antineoplastic therapy is introduced in the cancer fighting armamentarium; these accomplishments will usher a new era for improved outcomes in cancer patients who are susceptible to invasive fungal disease.