Recombinant urate oxidase prevents hyperuricaemia after
tumour cell lysis
TREATMENT of hyperuricaemia, a potentially life-threatening
complication associated with the treatment of haematological malignancies,
is set to improve as clinical trials show encouraging results with recombinant
urate oxidase (rasburicase).
Hyperuricaemia, a rapid increase in plasma uric
acid that can result in renal failure, can occur in at least half of patients
with haematological malignancies such as acute lymphoid leukaemia and
non-Hodgkin’s lymphoma. It results from the rapid breakdown of tumour
cells, known as tumour lysis syndrome (TLS), which can occur as part of
the disease, but can be exacerbated when patients start chemotherapy.
Dr Alan Boddy, chief pharmacist, Northern Institute
for Cancer Research, University of Newcastle, reported the results of
five clinical trials involving 347 adults and children with haematological
malignancies at a recent meeting of United Kingdom specialists held at
the Royal College of Pathologists, London. Rasburicase achieved an 83
per cent reduction (range not given) in uric acid levels as early as four
hours after the first dose. He suggested that the new agent offers an
improvement over allopurinol, the current treatment for TLS, which can
reduce the formation of uric acid but cannot break down the compound once
it has formed. Dr Boddy commented that the complication means chemotherapy
has to be delayed in some patients, which can potentially reduce chances
of survival. He concluded: “Rasburicase is highly effective in the treatment
of hyperuricaemia associated with TLS. Any treatment we can give to allow
patients to receive chemotherapy promptly is of great benefit.”
Urate oxidase is a naturally occurring enzyme in
many species which catalyses the breakdown of uric acid to allantoin,
so preventing hyperuricaemia, but it is not present in humans. Rasburicase
is a recombinant form of the enzyme, which has been shown rapidly to break
down uric acid in healthy volunteers and in patients. Rasburicase is being
developed by Sanofi-Synthelabo. It has been approved by the EMEA and will
be launched in the UK in the near future.
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