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Wang T, Zhu X, Chen Y, Shen S, Tang Y, Zhang J, He Y, Zhang H, Gao J, Fang J, Liu R, Wu X, Sun J, Zhang M. Safety and Effectiveness of Rasburicase in the Control of Hyperuricemia in Pediatric Patients with Non-Hodgkin's Lymphoma and Acute Leukemia: An Open-Label, Single-Arm, Multi-center, Interventional Study. Drugs R D 2023:10.1007/s40268-023-00420-y. [PMID: 37165291 DOI: 10.1007/s40268-023-00420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Despite rasburicase's proven efficiency in Caucasians, Japanese, and Koreans, studies evaluating the safety and effectiveness of rasburicase in Chinese pediatric patients with non-Hodgkin's lymphoma (NHL) and acute leukemia (AL) in particular are lacking. OBJECTIVE The aim was to evaluate the safety and effectiveness of rasburicase in Chinese pediatric patients with NHL and AL. METHODS In this phase IV, open-label, non-randomized, single-arm, multi-center, interventional study (NCT04349306), children newly diagnosed with NHL or AL who received 0.20 mg/kg/day of rasburicase were included. The primary objective was to assess the safety of rasburicase by the incidence of adverse events (AEs). The secondary objective was to determine the effectiveness of rasburicase in the control of hyperuricemia. RESULTS Out of 50 patients, 25 reported a total of 76 treatment-emergent adverse events (TEAEs), including eight TEAEs of grade ≥ 3 in 12 patients. A drug-related serious AE was reported in one patient, and there was no incidence of death. The response rate in the intent-to-treat population was 100.0% (95% confidence interval 82.4-100.0) in patients (n = 19) with baseline uric acid level of > 8.0 mg/dL. Similarly, the response rate was 86.2% (n = 25) among 29 patients (60.4%) with baseline uric acid levels of ≤ 8.0 mg/dL. The maximum mean percentage decrease of plasma uric acid level in the overall patients was 96.9%. CONCLUSION Rasburicase was well tolerated and effective in controlling hyperuricemia in Chinese pediatric patients with NHL and AL.
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Affiliation(s)
- Tianyou Wang
- Department of Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, People's Republic of China.
| | - Xiaofan Zhu
- Department of Hematology, Chinese Academy of Medical Sciences, Hematology Hospital, Heping District, Tianjing, China
| | - Yumei Chen
- Department of Hematology, Chinese Academy of Medical Sciences, Hematology Hospital, Heping District, Tianjing, China
| | - Shuhong Shen
- Department of Hematology, Shanghai Children's Medical Center, Dongfang Road, Shanghai, China
| | - Yongmin Tang
- Department/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Gongshu District, Hangzhou City, Zhejiang Province, China
| | - Jingying Zhang
- Department/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Gongshu District, Hangzhou City, Zhejiang Province, China
| | - Yingyi He
- Department of Pediatric Hematology/Oncology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, China
| | - Hui Zhang
- Department of Pediatric Hematology/Oncology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, China
| | - Ju Gao
- Department of Hematology, West China Second University Hospital, Chengdu, Sichuan Province, China
| | - Jianpei Fang
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, West Yanjiang Road, Guangzhou, China
| | - Rong Liu
- Department of Hematology, Children's Hospital Capital Institute of Pediatrics, Chaoyang District, Beijing, China
| | - Xiaoyan Wu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Hematologic and Oncologic Emergencies. Crit Care Nurs Q 2023; 46:100-113. [DOI: 10.1097/cnq.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mirzaee Godarzee M, Mahmud Hussen B, Razmara E, Hakak‐Zargar B, Mohajerani F, Dabiri H, Fatih Rasul M, Ghazimoradi MH, Babashah S, Sadeghizadeh M. Strategies to overcome the side effects of chimeric antigen receptor T cell therapy. Ann N Y Acad Sci 2022; 1510:18-35. [DOI: 10.1111/nyas.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/05/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | - Bashdar Mahmud Hussen
- Department of Pharmacognosy, College of Pharmacy Hawler Medical University Erbil Iraq
| | - Ehsan Razmara
- Australian Regenerative Medicine Institute Monash University, Clayton, Victoria, Australia, 3800
| | | | - Fatemeh Mohajerani
- Department of Molecular Genetics, Faculty of Biological Sciences Tarbiat Modares University Tehran Iran
| | - Hamed Dabiri
- Department of Molecular Genetics, Faculty of Biological Sciences Tarbiat Modares University Tehran Iran
| | - Mohammed Fatih Rasul
- Department of Medical Analysis, Faculty of Sciences Tishk International University Erbil Iraq
| | | | - Sadegh Babashah
- Department of Molecular Genetics, Faculty of Biological Sciences Tarbiat Modares University Tehran Iran
| | - Majid Sadeghizadeh
- Department of Molecular Genetics, Faculty of Biological Sciences Tarbiat Modares University Tehran Iran
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Bi Q, Luo R, Li Y, Zhao J, Fu X, Chen H, Lv Y, Liu Z, Liang Q, Tang Q. Low Inorganic Phosphate Stress Inhibits Liver Cancer Progression: from In Vivo to In Vitro. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202100224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Qiu‐Chen Bi
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health Nanchang University Nanchang 330031 China
- Institute for Advanced Study Nanchang University Nanchang 330031 China
| | - Rong‐Guang Luo
- Department of Medical Imaging and Interventional Radiology The First Affiliated Hospital of Nanchang University Nanchang 330006 China
| | - Yan‐Shu Li
- Jiangxi Center of Medical Device Testing Nanchang 330029 China
| | - Jun Zhao
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health Nanchang University Nanchang 330031 China
| | - Xin Fu
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health Nanchang University Nanchang 330031 China
| | - Hong Chen
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health Nanchang University Nanchang 330031 China
| | - Yang‐Feng Lv
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health Nanchang University Nanchang 330031 China
- Institute for Advanced Study Nanchang University Nanchang 330031 China
| | - Zhi‐Xing Liu
- Department of Ultrasonic Radiology The First Affiliated Hospital of Nanchang University Nanchang 330006 China
| | - Qing‐Rong Liang
- Institute for Advanced Study Nanchang University Nanchang 330031 China
| | - Qun Tang
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health Nanchang University Nanchang 330031 China
- Institute for Advanced Study Nanchang University Nanchang 330031 China
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Tumielewicz KL, Hudak D, Kim J, Hunley DW, Murphy LA. Review of oncological emergencies in small animal patients. Vet Med Sci 2019; 5:271-296. [PMID: 30900396 PMCID: PMC6682806 DOI: 10.1002/vms3.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Oncological emergencies can occur at any time during the course of a malignancy and need to be recognized promptly to maximize successful outcomes. Emergencies are characterized as chemotherapy-induced, paraneoplastic syndromes, or directly related to the neoplasm. Prompt identification with treatment of these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. This review aims to educate the reader on the pathophysiology, clinical presentation and treatment of some of these emergencies, and to review the current veterinary literature to help educate veterinarians in primary and tertiary facilities to know how to diagnose and treat these serious conditions.
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Affiliation(s)
| | - Danielle Hudak
- Cornell University College of Veterinary MedicineIthacaNew JerseyUSA
| | | | | | - Lisa A. Murphy
- Veterinary Specialty Center of DelawareNewcastleDelawareUSA
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Strilchuk L, Fogacci F, Cicero AF. Safety and tolerability of available urate-lowering drugs: a critical review. Expert Opin Drug Saf 2019; 18:261-271. [PMID: 30915866 DOI: 10.1080/14740338.2019.1594771] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Urate-lowering therapy (ULT) is the cornerstone of gout management, which is a widespread chronic illness characterized by hyperuricemia, arthropathy, tophus development, and urolithiasis. Since asymptomatic increased serum urate levels are associated with a higher risk of cardiovascular, renal and metabolic disorders, a larger use of ULTs in the general population is expected in the near future. AREAS COVERED This review will focus on the safety and tolerability profile of the available urate-lowering drugs: xanthine oxidase inhibitors (XOIs), uricosuric agents and injectable uricases. EXPERT OPINION Older drugs for ULT like allopurinol are well studied and extensively described from typical adverse effects (mild skin rash) to unusual fatal reactions, while febuxostat seems to be overall well tolerated. More evidence is required to define the safety profile of topiroxostat, arhalofenate, tranilast, and sulfinpyrazone. Furthermore, there are some unanswered questions about the pharmacological interactions of probenecid and the hepatotoxicity of benzbromarone. Despite a limited use in clinical practice, combination therapy with lesinurad or verinurad and XOI is not frequently accompanied by side effects. Rasburicase and pegloticase are usually well tolerated with some specific exceptions. Before prescribing UL drugs, physicians should take into account their safety profile tailoring the treatment on the patient characteristics.
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Affiliation(s)
- Larysa Strilchuk
- a Department of Therapy and Medical Diagnostics , Lviv National Medical University , Lviv , Ukraine
| | - Federica Fogacci
- b Medical and Surgical Sciences Department , Alma Mater Studiorum University of Bologna , Bologna , Italy
| | - Arrigo Fg Cicero
- b Medical and Surgical Sciences Department , Alma Mater Studiorum University of Bologna , Bologna , Italy.,c Medical and Surgical Sciences Department , Sant'Orsola-Malpighi University Hospital , Bologna , Italy
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Dhakal P, Rai MP, Thrasher M, Sharma M. Spontaneous tumour lysis syndrome in small cell lung cancer: a rare phenomenon. BMJ Case Rep 2018; 2018:bcr-2018-224512. [PMID: 29898908 DOI: 10.1136/bcr-2018-224512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Tumour lysis syndrome (TLS) is an oncological emergency. It is caused by cellular death occurring secondary to cancer therapy or spontaneously in rapidly dividing tumours. More common in haematological malignancies, it has also been reported in solid tumours. Out of 14 cases of small cell lung cancer (SCLC) with TLS, only three cases of spontaneous TLS have been reported in literature to date. Here we report a case of SCLC presenting as a spontaneous TLS.
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Affiliation(s)
- Prajwal Dhakal
- Internal Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Manoj P Rai
- Internal Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Modina Thrasher
- Department of Pathology, Sparrow Hospital, Lansing, Michigan, USA
| | - Mukta Sharma
- Internal Medicine, Michigan State University, East Lansing, Michigan, USA
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Abstract
Cancer and its therapies may lead to several metabolic emergencies that emergency providers (EPs) should be well-versed in identifying and managing. With prompt recognition and treatment initiation in the emergency department, lives can be saved and quality of life maintained. Most oncologic metabolic emergencies occur in advanced cancer states, but some follow initiation of treatment or may be the presenting syndrome that leads to the cancer diagnosis. This article reviews the 2 most emergent oncologic metabolic diagnoses: tumor lysis syndrome and hypercalcemia of malignancy. A discussion on associated cancers and conditions, pathogenesis and pathophysiology, and management recommendations is included.
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Affiliation(s)
- Jonathan Wagner
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, 1200 North State Street, Room 1011, Los Angeles, CA 90033, USA.
| | - Sanjay Arora
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, 1200 North State Street, Room 1011, Los Angeles, CA 90033, USA
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Alakel N, Middeke JM, Schetelig J, Bornhäuser M. Prevention and treatment of tumor lysis syndrome, and the efficacy and role of rasburicase. Onco Targets Ther 2017; 10:597-605. [PMID: 28203093 PMCID: PMC5295804 DOI: 10.2147/ott.s103864] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Tumor lysis syndrome (TLS) is a potentially life-threatening condition that occurs in oncologic and hematologic patients with large tumor burden, either due to cytotoxic therapy or, less commonly, spontaneously because of massive tumor cell lysis. TLS is clinically characterized by acute renal failure, hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. While limited options are available for treating TLS, identifying patients at high risk for developing TLS and prevention in high-risk patients remain an important aspect in the treatment of cancer patients. In general, treatment of TLS consists of intensive hydration, stimulation of diuresis, and, more specifically, in the use of allopurinol and rasburicase. Rasburicase, a recombinant urate oxidase, rapidly and effectively reduces hyperuricemia, which subsequently significantly decreases the risk of acute renal failure and other clinical manifestations of TLS. For this review, a comprehensive literature search using the term “tumor lysis syndrome” and/or “rasburicase” was performed considering articles listed in MEDLINE. Incidence, prevention, and therapy of TLS with a special focus on the role of rasburicase are discussed. We evaluated 120 relevant articles including 35 case reports, 32 clinical trials, and 14 meta-analyses.
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Affiliation(s)
- Nael Alakel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Dresden
| | - Jan Moritz Middeke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Dresden
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Dresden; German Bone Marrow Donor Center DKMS, Tübigen, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Dresden
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Takeuchi N, Miyazawa S, Ohno Z, Yoshida S, Tsukamoto T, Fujiwara M. A Case of Spontaneous Tumor Lysis Syndrome in Malignant Melanoma. World J Oncol 2016; 7:40-44. [PMID: 28983362 PMCID: PMC5624695 DOI: 10.14740/wjon970w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 11/20/2022] Open
Abstract
A 62-year-old man with a complaint of back pain lasting 2 months was admitted. He also presented a huge abdominal tumor. Diagnostic imaging showed metastatic tumors in the liver, lumbar vertebrae and bilateral lung. An ultrasound-guided needle biopsy revealed a lung tumor containing melanic tissue. Subsequently, there was an evident elevation in uric acid, phosphoric acid, potassium and lactate dehydrogenase concentrations in serum. Continuous hemodiafiltration and administration of rasburicase was initiated following the diagnosis of tumor lysis syndrome (TLS). However, he died on the fourth day owing to arrhythmia. An autopsy revealed metastatic deposits in the liver, lung, spine, ribs, and lymph nodes along the biliary system. Microscopic examinations revealed massive necrosis of normal hepatocytes and tumor cells with disseminated tumor thrombi in the portal system. The catastrophic progression of TLS appears to be influenced by a persistent portal blood flow deficiency by portal tumor thrombus in this case.
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Affiliation(s)
- Nobumichi Takeuchi
- Department of Medical Oncology, Ina Central Hospital, 1313-1 Koshirou-Kubo, Ina-city, Nagano 396-8555, Japan
| | - Shun Miyazawa
- Department of Medical Oncology, Ina Central Hospital, 1313-1 Koshirou-Kubo, Ina-city, Nagano 396-8555, Japan
| | - Zentaro Ohno
- Department of Medical Oncology, Ina Central Hospital, 1313-1 Koshirou-Kubo, Ina-city, Nagano 396-8555, Japan
| | - Sonomi Yoshida
- Department of Medical Oncology, Ina Central Hospital, 1313-1 Koshirou-Kubo, Ina-city, Nagano 396-8555, Japan
| | - Tetsu Tsukamoto
- Department of Pathology, Tokyo Medical University Hachiouji Medical Center, 1163 Tatemachi, Hachiouji, Tokyo 193-0998, Japan
| | - Masayuki Fujiwara
- Department of Pathology, Ina Central Hospital, 1313-1 Koshirou-Kubo, Ina-city, Nagano 396-8555, Japan
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Analysis of the landscape of biologically-derived pharmaceuticals in Europe: dominant production systems, molecule types on the rise and approval trends. Eur J Pharm Sci 2012; 48:428-41. [PMID: 23262060 DOI: 10.1016/j.ejps.2012.11.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/20/2012] [Accepted: 11/23/2012] [Indexed: 12/12/2022]
Abstract
A thorough sort of the human drugs approved by the European Medicines Agency (EMA) between its establishment in 1995 until June 2012 is presented herein with a focus on biologically-derived pharmaceuticals. Over 200 (33%) of the 640 approved therapeutic drugs are derived from natural sources, produced via recombinant DNA technology, or generated through virus propagation. A breakdown based on production method, type of molecule and therapeutic category is presented. Current EMA approvals demonstrate that mammalian cells are the only choice for glycoprotein drugs, with Chinese hamster ovary cells being the dominant hosts for their production. On the other hand, bacterial cells and specifically Escherichia coli are the dominant hosts for protein-based drugs, followed by the yeast Saccharomyces cerevisiae. The latter is the dominant host for recombinant vaccine production, although egg-based production is still the main platform of vaccine provision. Our findings suggest that the majority of biologically-derived drugs are prescribed for cancer and related conditions, as well as the treatment of diabetes. The approval rate for biologically-derived drugs shows a strong upward trend for monoclonal antibodies and fusion proteins since 2009, while hormones, antibodies and growth factors remain the most populous categories. Despite a clear pathway for the approval of biosimilars set by the EMA and their potential to drive sales growth, we have only found approved biosimilars for three molecules. In 2012 there appears to be a slow-down in approvals, which coincides with a reported decline in the growth rate of biologics sales.
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Affiliation(s)
- Scott C Howard
- Department of Oncology and International Outreach Program, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
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