Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Jan 13:10:23-38.
doi: 10.2147/CE.S54995. eCollection 2015.

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

Jennifer Dinnel  1 , Bonny L Moore  1 , Brent M Skiver  1 , Prithviraj Bose  2
Affiliations
Review

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

Jennifer Dinnel et al. Core Evid. .

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: evidence; hyperuricemia; rasburicase; tumor lysis syndrome; urate oxidase; uric acid.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Search strategy used and number of articles found in each category.
See this image and copyright information in PMC

References

    1. Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 2004;127(1):3–11. - PubMed
    1. Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med. 2011;364(19):1844–1854. - PMC - PubMed
    1. Coiffier B. Acute tumor lysis syndrome – a rare complication in the treatment of solid tumors. Onkologie. 2010;33(10):498–499. - PubMed
    1. Darmon M, Guichard I, Vincent F, Schlemmer B, Azoulay E. Prognostic significance of acute renal injury in acute tumor lysis syndrome. Leuk Lymphoma. 2010;51(2):221–227. - PubMed
    1. Shimada M, Johnson RJ, May WS, et al. A novel role for uric acid in acute kidney injury associated with tumour lysis syndrome. Nephrol Dial Transplant. 2009;24(10):2960–2964. - PubMed