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Tumor lysis syndrome (TLS) is a major onco-metabolic entity requiring emergent recognition and management. In our analysis of 398 cases of TLS at UTMD Anderson Cancer Center in 2018, we found that almost 60% (240 cases) needed repeated doses of rasburicase, often up to 3 doses several days apart to bring the serum uric acid down to 6.0 and help with recovery of acute kidney injury (AKI).
Pegloticase is a PEGylated version of uricase which has a longer half-life than rasburicase and is reported to bring the uric acid levels down to zero (undetectable) in 24 hours after IV infusion. Given that 60% of patients need more than one dose of Rasburicase, Pegloticase with its longer half-life and improved efficacy could be a better option for treating patients with hyperuricemia in the setting of Tumor Lysis Syndrome
Patients admitted to MD Anderson Cancer Center with ongoing tumor lysis syndrome as determined by type of cancer considered high risk for TLS by MDACC criteria and elevated uric acid were identified as potential subjects. After obtaining confirmation from treating oncologist about high risk for TLS, patients signed informed consent, G6PD screening was performed and patient were given a single dose of Pegloticase IV ( with rescue therapy on day 2 if needed). All patients were followed with daily labs including uric acid for duration of hospital stay upto 4 weeks after infusion. AEs were determined by study coordinator from EMR and labs and interview with subjects.
24 patients were screened over a period of 6 months, 6 met all inclusion and exclusion criteria and signed consent. 5 subjects were dosed a single dose of Pegloticase and followed for 4 weeks. 4 out of 5 patients reached uric acid levels < 0.4 mg/dl around 24 hours after Pegloticase treatment ended. 5 out of 5 patients had uric acid values < 6 mg/dL at 20 to 32 days after pegloticase treatment: 4.1, 2.7, 2.3, 1.7 and 0.7 . 4 out of 5 patients achieved a decrease in uric acid < 6 mg/dL within 5 to 7 hours after receiving pegloticase treatment. 5 out of 5 patients achieved a uric acid level of < 0.4 mg/dl after Pegloticase treatment. None of the patients reported any AE`s from the treatment. None of the 5 patients needed dialysis, ICU transfer or delay in administration of subsequent chemotherapy.
Pegloticase is extremely effective and safe in cancer patients with severe tumor lysis syndrome. None of the patients who received Pegloticase ended up needing dialysis, ICU transfer or prolonged hospitalization