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Sidhu J, Gogoi MP, Agarwal P, Mukherjee T, Saha D, Bose P, Roy P, Phadke Y, Sonawane B, Paul P, Saha V, Krishnan S. Unsatisfactory quality of E. coli asparaginase biogenerics in India: Implications for clinical outcomes in acute lymphoblastic leukaemia. Pediatr Blood Cancer 2021; 68:e29046. [PMID: 33939263 PMCID: PMC7613163 DOI: 10.1002/pbc.29046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/01/2021] [Accepted: 03/13/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The biotherapeutic asparaginase is a cornerstone of therapy in acute lymphoblastic leukaemia (ALL). With limited access to the original native Escherichia coli-derived asparaginase (EcASNase), a variety of EcASNase biogenerics are used in low-middle-income countries (LMICs). The variable quality of these biogenerics potentially influences clinical outcomes. PROCEDURE Seven biogeneric EcASNases (P1-P7) marketed widely in India were evaluated, with P2 as an exemplar for in vivo monitoring. Therapeutic activity of P2 (10,000 IU/m2 /dose, intramuscular, every 72 hours) was monitored during induction therapy, and drug-related toxicities recorded. Molecular identity, purity and in vitro drug activity of seven biogenerics were characterised using multimodal analyses, and findings compared with reference EcASNase (R). RESULTS In patients (N = 62) receiving P2, subtherapeutic asparaginase activity (<100 U/L) was observed in 66% (46/70) of trough timepoints (72 hours postdose) during induction. Twelve patients (19%), 11 with high-risk ALL, developed hypersensitivity. Isoforms of EcASNase were identified in all seven biogenerics. All generic products contained impurities with batch-to-batch variability. These included high levels of protein aggregates and host cell protein contamination. In vitro assays of EcASNase activity and leukaemia cell line cytotoxicity were not discriminatory. CONCLUSIONS Our findings confirm widespread concerns over the unsatisfactory quality and therapeutic activity of native EcASNase biogenerics marketed in LMICs. Appropriate use of these products requires monitored studies to identify clinical suitability and determine appropriate dosing and schedule. For large parts of the world, assured access to high-quality asparaginases remains an unmet therapeutic need.
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Affiliation(s)
- Jasmeet Sidhu
- Department of Paediatric Haematology and Oncology, Tata Medical Center, Kolkata, India,Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India
| | - Manash Pratim Gogoi
- Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India
| | - Praveen Agarwal
- Gennova Vaccine Formulation and Research Centre, Pune, India
| | | | - Debparna Saha
- Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India
| | - Priyanka Bose
- Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India
| | - Prakriti Roy
- Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India
| | - Yogesh Phadke
- Gennova Vaccine Formulation and Research Centre, Pune, India
| | - Bhatu Sonawane
- Gennova Vaccine Formulation and Research Centre, Pune, India
| | - Pritha Paul
- Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester,UK
| | - Vaskar Saha
- Department of Paediatric Haematology and Oncology, Tata Medical Center, Kolkata, India,Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester,UK
| | - Shekhar Krishnan
- Department of Paediatric Haematology and Oncology, Tata Medical Center, Kolkata, India,Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester,UK
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Liu WJ, Wang H, Peng XW, Wang WD, Liu NW, Wang Y, Lu Y. Asparagine synthetase expression is associated with the sensitivity to asparaginase in extranodal natural killer/T-cell lymphoma in vivo and in vitro. Onco Targets Ther 2018; 11:6605-6615. [PMID: 30349294 PMCID: PMC6188207 DOI: 10.2147/ott.s155930] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Although asparagine synthetase (AsnS) is associated with drug resistance in leukemia, its function in extranodal natural killer (NK)/T-cell lymphoma (ENKTL) remains unclear. Methods The present study investigated the relationship between baseline AsnS mRNA levels and response to asparaginase in ENKTL cell lines. It also determined whether upregulating or downregulating the AsnS mRNA level induces or reverses asparaginase-resistant phenotype. Results Interestingly, considerable differences were observed in the sensitivity to asparaginase of the five ENKTL cell lines. The AsnS expression levels were positively correlated with the IC50 values. In addition, the asparaginase resistance was induced or reversed by upregulating or downregulating the AsnS mRNA level in vivo and in vitro. Functional analyses indicated that AsnS did not affect the proliferation and apoptosis of ENKTL cells in the absence of asparaginase. Conclusion Together, the data stress the importance of AsnS in the sensitivity to asparaginase in ENKTL and suggest a different therapeutic strategy for patients with a different level of AsnS expression.
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Affiliation(s)
- Wen-Jian Liu
- Laboratory of Hematology Oncologytate, Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China, .,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China,
| | - Hua Wang
- Laboratory of Hematology Oncologytate, Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China, .,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China,
| | - Xiong-Wen Peng
- Laboratory of Hematology Oncologytate, Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China, .,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China,
| | - Wei-da Wang
- Laboratory of Hematology Oncologytate, Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China, .,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China,
| | - Na-Wei Liu
- Laboratory of Hematology Oncologytate, Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China, .,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China,
| | - Yang Wang
- Laboratory of Hematology Oncologytate, Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China, .,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China,
| | - Yue Lu
- Laboratory of Hematology Oncologytate, Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China, .,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China,
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Burke PW, Aldoss I, Lunning MA, Devlin SM, Tallman MS, Pullarkat V, Mohrbacher AM, Douer D. Pegaspargase-related high-grade hepatotoxicity in a pediatric-inspired adult acute lymphoblastic leukemia regimen does not predict recurrent hepatotoxicity with subsequent doses. Leuk Res 2018; 66:49-56. [DOI: 10.1016/j.leukres.2017.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 12/02/2017] [Accepted: 12/31/2017] [Indexed: 01/27/2023]
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Ribera JM, Morgades M, Montesinos P, Martino R, Barba P, Soria B, Bermúdez A, Moreno MJ, González-Campos J, Vives S, Gil C, Abella E, Guàrdia R, Martínez-Carballeira D, Martínez-Sánchez P, Amigo ML, Mercadal S, Serrano A, López-Martínez A, Vall-Llovera F, Sánchez-Sánchez MJ, Peñarrubia MJ, Calbacho M, Méndez JA, Bergua J, Cladera A, Tormo M, García-Belmonte D, Feliu E, Ciudad J, Orfao A. Efficacy and safety of native versus pegylated Escherichia coli asparaginase for treatment of adults with high-risk, Philadelphia chromosome-negative acute lymphoblastic leukemia. Leuk Lymphoma 2017; 59:1634-1643. [PMID: 29165013 DOI: 10.1080/10428194.2017.1397661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Native or pegylated (PEG) asparaginase (ASP) are commonly used in treatment of acute lymphoblastic leukemia (ALL), but have been scarcely compared in the same trial in adult patients. Native vs. PEG-ASP administered according to availability in each center were prospectively evaluated in adults with high-risk ALL. Ninety-one patients received native ASP and 35 PEG-ASP in induction. No significant differences were observed in complete remission, minimal residual disease levels after induction and after consolidation, disease-free survival, and overall survival. No significant differences in grades 3-4 toxicity were observed in the induction period, although a trend for higher hepatic toxicity was observed in patients receiving PEG-ASP. In this trial the type of ASP did not influence patient response and outcome.
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Affiliation(s)
- Josep-Maria Ribera
- a ICO Badalona-Hospital Germans Trias i Pujol , Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Mireia Morgades
- a ICO Badalona-Hospital Germans Trias i Pujol , Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Pau Montesinos
- b Hospital Universitari i Politècnic La Fe , Valencia , Spain
| | | | - Pere Barba
- d Hospital Vall d'Hebron Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Beatriz Soria
- e Hospital Universitario de Canarias , Santa Cruz de Tenerife , Spain
| | - Arancha Bermúdez
- f Hospital Universitario Marqués de Valdecilla , Santander , Spain
| | - María-José Moreno
- g Hospital Clínico Universitario Virgen de la Victoria , Málaga , Spain
| | | | - Susana Vives
- a ICO Badalona-Hospital Germans Trias i Pujol , Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Cristina Gil
- i Hospital General de Alicante , Alicante , Spain
| | | | | | | | | | | | - Santiago Mercadal
- o ICO L'Hospitalet-Hospital Duran i Reynals, L'Hospitalet de Llobregat , L'Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | - Juan Bergua
- w Hospital San Pedro de Alcántara , Cáceres , Spain
| | | | - Mar Tormo
- y Hospital Clínico Universitario de Valencia , Valencia , Spain
| | | | - Evarist Feliu
- a ICO Badalona-Hospital Germans Trias i Pujol , Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Juana Ciudad
- aa Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC), Servicio General de Citometría, and Instituto de Investigación Biomédica de Salamanca (IBSAL) , Universidad de Salamanca , Salamanca , Spain
| | - Alberto Orfao
- aa Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC), Servicio General de Citometría, and Instituto de Investigación Biomédica de Salamanca (IBSAL) , Universidad de Salamanca , Salamanca , Spain
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