Rasburicase: A New Approach for Preventing and/or Treating Tumor Lysis Syndrome

Abstract

Tumor lysis syndrome (TLS) is an oncologic emergency requiring prompt attention to the management of potentially life-threatening metabolic derangements. Hyperuricaemia is one of the prominent features of TLS which, if not adequately prevented or treated, may lead to renal failure, requiring dialysis. Conventional management of hyperuricaemia involved the use of aggressive hydration, urinary alkalinization and allopurinol. Despite these measures, as many as 14.1% of high-risk patients may still develop renal failure. With the advent of newer agents such as rasburicase, the paradigm of TLS management has shifted towards risk stratification and the use of rasburicase in conjunction with hydration in patients at high risk for TLS. The advantage of rasburicase over allopurinol is its rapid onset of action, lack of need for urine alkalinization, which may worsen hyperphosphataemia and a satisfactory safety profile. Overall, rasburicase offers a safe and more effective alternative to allopurinol in patients at highest risk for TLS. Some of the unanswered questions requiring further investigation with regard to rasburicase use include the optimal number of doses needed, optimal dose based on uric acid levels and tumor burden, dosing in obese patients and maximum dose.

Tumor lysis syndrome: current perspective

“…Allopurinol is generally given at a dose of at least 300 mg/m 2 day. 30 It is known to interfere with the degradation of 6-mercaptopurine, 6-thioguanine, and azathioprine through inhibition of the p450 pathway. Thus the dose of allopurinol should be reduced 50-75% in patients receiving these chemotherapeutic agents.…”

An unusual case of spontaneous acute tumor lysis syndrome associated with acute lymphoblastic leukemia: A case report and review of the literature

“…A xanthine oxidase inhibitor, allopurinol, should be added to lower plasma uric acid concentration [1,4,16]. Rasburicase, a new recombinant form of urate oxidase, is a safe and more effective drug than allopurinol in patients at highest risk for TLS because of its rapid onset of action, lack of need for urine alkalinization and a satisfactory safety profile [20]. Hemodialysis should be administered to control life-threatening hyperkalemia or volume overload in patients who have persistent oliguria despite aggresssive hydration [4].…”

Enzymes, 6. Enzymes in Therapy

“…1.7.3.3), an enzyme which catalyzes the oxidation of uric acid to the more [39]. Use of rasburicase in cancer treatment is under study [40].…”