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Rasburicase in the management of tumor lysis: an evidence-based review of its place in therapy

Authors Dinnel J, Moore B, Skiver B, Bose P

Received 25 September 2014

Accepted for publication 11 November 2014

Published 13 January 2015 Volume 2015:10 Pages 23—38

DOI https://doi.org/10.2147/CE.S54995

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Gulshan Sharma

Jennifer Dinnel,1 Bonny L Moore,1 Brent M Skiver,1 Prithviraj Bose1,2

1Department of Internal Medicine, Virginia Commonwealth University, 2VCU Massey Cancer Center, Richmond, VA, USA


Abstract: Tumor lysis syndrome (TLS) is a potentially life-threatening complication of cancer therapy characterized by two or more of the following laboratory abnormalities: hyperuricemia, hyperkalemia, hypocalcemia, and hyperphosphatemia, with resultant end-organ damage, eg, renal failure, seizures, or cardiac arrhythmias. High-risk patients include those with highly proliferative cancers and/or large tumor burdens, particularly in the setting of highly effective chemotherapy, among other risk factors. Before 2002, antihyperuricemic drug therapy was limited to allopurinol, a xanthine oxidase inhibitor. Rasburicase, a recombinant urate oxidase, was approved by the US Food and Drug Administration for children in 2002 and adults in 2009, ushering in a new era in TLS therapy. We attempted to critically appraise the available evidence supporting the perceived benefits of rasburicase in the management of TLS. A Medline search yielded 98 relevant articles, including 26 retrospective and 22 prospective studies of rasburicase for the treatment of TLS, which were then evaluated to determine the best available evidence for the effectiveness of rasburicase in terms of disease-oriented, patient-oriented, and economic outcomes. Rasburicase is now a standard of care for patients at high risk of TLS despite continuing debate on the correlation between its profound and rapid lowering of plasma uric acid levels with hard patient outcomes, eg, need for renal replacement therapy and mortality. Rasburicase is dramatically effective in lowering plasma uric acid levels. The mortality and cost-effectiveness benefits of this expensive drug remain to be conclusively proven, and well designed, randomized controlled trials are needed to answer these fundamentally important questions.

Keywords: rasburicase, hyperuricemia, uric acid, urate oxidase, tumor lysis syndrome, evidence

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