Managing malignancy-associated hyperuricemia with rasburicase.
Along with hydration and urinary alkalinization, allopurinol has been the standard agent for the management of hyperuricemia in patients with a high tumor burden who are at risk for tumor lysis syndrome. However, this agent often fails to prevent and treat this complication effectively. Rasburicase, a recombinant urate oxidase, acts at the end of the purine catabolic pathway and, therefore, does not induce accumulation of xanthine or hypoxanthine, which can precipitate in the kidneys and lead to impaired renal function. Rasburicase may represent an effective alternative to allopurinol in rapidly reducing uric acid levels, improving patients' electrolyte status, and reversing renal insufficiency. The drug initially was studied in pediatric patients with acute lymphoblastic leukemia and aggressive non-Hodgkin lymphoma; data may suggest comparable benefit in adults with similar lymphoid malignancies. Current and future trials will evaluate alternate doses and schedules of rasburicase to maintain its efficacy while reducing its cost.
Cheson
Bruce D
BD
Georgetown University, Lombardi Comprehensive Cancer, Center, Washington, DC 20007, USA. bdc4@georgetown.edu
Dutcher
Bonni S
BS
D000493:Allopurinol / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D005334:Fever / Q000139:chemically induced; D016166:Free Radical Scavengers / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D033461:Hyperuricemia / Q000188:drug therapy* / Q000209:etiology; D009369:Neoplasms / Q000150:complications; D016896:Treatment Outcome; D015275:Tumor Lysis Syndrome / Q000188:drug therapy* / Q000209:etiology; D014503:Urate Oxidase / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D014839:Vomiting / Q000139:chemically induced
D016166:Free Radical Scavengers; C469709:rasburicase; D000493:Allopurinol; D014503:Urate Oxidase