The topoisomerase I inhibitor payload (DXd) released from the human epidermal growth factor receptor 2-targeted antibody-drug conjugate (ADC) trastuzumab deruxtecan (T-DXd) is eliminated by hepatic uptake via OATP1B1/3, metabolism by CYP3A, biliary excretion via P-glycoprotein and breast cancer resistance protein, and urinary excretion. DDIs with ritonavir and itraconazole simulated by the PBPK model reproduced the clinical DDI study results, indicating that the impact of concomitant medications was not clinically meaningful. These findings suggest that this model may potentially be used for DDI evaluation of future DXd-containing ADCs, aiding in the prediction of DDIs under different scenarios and in specific populations.

Voriconazole and itraconazole are commonly used for maintenance therapy. Treatment and long-time management remain a challenge. Besides, long lasting anti-fungal and immune boosting therapy may be necessary, while HSCT intervention could provide potential benefits.

P=N/A, N=114, Recruiting, Guy's and St Thomas' NHS Foundation Trust | Not yet recruiting --> Recruiting

P4, N=30, Recruiting, Mayo Clinic | Initiation date: Mar 2026 --> Jun 2026

Treatment consisted of oral ketoconazole 400 mg daily for six months, resulting in complete clinical recovery with radiographic evidence of bone healing at one‑year follow-up. In conclusion, this case underscores the critical need to consider fungal etiologies in the differential diagnosis of subacute osteomyelitis, even in young patients without traditional risk factors. A high index of suspicion, combined with early surgical intervention and targeted antifungal therapy, is paramount for achieving a favorable clinical outcome and preventing long‑term morbidity.

Ectopic adrenocorticotropic hormone syndrome was confirmed via dexamethasone suppression testing and somatostatin receptor-targeted positron emission tomography-computed tomography, which localized an ectopic adrenocorticotropic hormone-secreting right pulmonary carcinoid tumor (a neuroendocrine tumor). During hospitalization, the patient was diagnosed with concurrent Pneumocystis jirovecii pneumonia and pulmonary cryptococcosis, and he responded favorably to trimethoprim-sulfamethoxazole and fluconazole. This case, supported by a review of the relevant literature, highlights the importance of early infection diagnosis, prompt management, and appropriate prophylaxis in patients with ectopic adrenocorticotropic hormone syndrome to improve prognosis.

Treatment was individualized: severe cases received extended amphotericin B lipid complex (ABLC) (cumulative dose up to 31.8g in case1) induction followed by azole maintenance; milder cases received oral itraconazole alone...NGS was essential for early detection. Individualized antifungal therapy-tailored to immune status and disease severity achieved favorable outcomes, underscoring the importance of personalized treatment strategies.

P1, N=14, Not yet recruiting, Pfizer

Coupled with the decrease in tumour size, a decrease in the expression of CD105, an endothelial marker (p < 0.0001), was observed. In conclusion, neoadjuvant itraconazole for 2 months was able to reduce the diameter of low-risk BCC, and the effect was associated with a decrease in tumour angiogenesis and a favourable safety profile.

P1, N=120, Active, not recruiting, University of Manitoba | Recruiting --> Active, not recruiting | Trial completion date: Apr 2026 --> Apr 2030 | Trial primary completion date: Apr 2025 --> Apr 2029

Preliminary safety evaluation revealed no significant hematological or organ toxicity. These results established truncated-ITZ analogues as promising HH/GLI pathway inhibitors and support further development of compound 16 as a potential therapeutic agent for cSCC.

P1, N=36, Recruiting, Zagazig University | Not yet recruiting --> Recruiting | Trial completion date: Dec 2024 --> Dec 2026 | Trial primary completion date: Jul 2024 --> Jul 2026