Invasive Fungal Disease in Immunocompromised Children: Current and Emerging Therapies

In an era of expanding indications for iatrogenic immunosuppression, invasive fungal disease (IFD) remains a significant challenge in immunocompromised children, with case fatality rates ranging from 10 to 70%. Understanding of current recommendations and recent evidence is essential to guide optimal IFD management.

Recent international guideline guidelines are largely aligned in recommending echinocandins as first line therapy for invasive candidiasis, voriconazole as first line therapy for invasive aspergillosis, and liposomal amphotericin B for mucormycosis. Clinical pharmacology and data supporting use of available newer antifungals including posaconazole and isavuconazole in children, as well as emerging agents olorofim, ibrexafungerp and fosmanogepix, which have emerged more recently, potentially broadening the arsenal of agents available for treatment of IFD. In future, immunotherapies for IFD, including novel approaches to immunosuppression reduction, and biological therapies in childhood cancer have potential to further improve outcomes in paediatric IFD.

Treatment of IFD in immunocompromised children remains challenging, although recent international guidelines are broadly aligned in treatment recommendations, despite a historic paucity of paediatric specific data. Emerging approaches including the use of novel antifungal formulations and agents as well as adjuvant immunotherapy have shown promise, with an ongoing need for appropriate assessment in paediatric patients.