PEGASPARGASE

Background and Date of Approval

Pegaspargase is a chemotherapy medication containing pegaspargase as its active ingredient. It is indicated for the treatment of Acute Lymphoblastic Leukemia (ALL), a type of blood cancer affecting white blood cells. In ALL, immature white cells proliferate uncontrollably, impairing the production of functional blood cells. When used in combination with other chemotherapy agents, pegaspargase can enhance the likelihood of remission and long-term survival in patients with ALL. The medication received initial FDA approval in 1994 for leukaemia treatment and has subsequently gained approval in various other countries. Pegaspargase is a prescription medication and must be administered only under the supervision of a qualified healthcare provider. It demonstrates particular effectiveness in treating paediatric patients with ALL, who exhibit higher rates of remission and overall survival when the drug is incorporated into their treatment regimen.

Uses

Pegaspargase is an antineoplastic agent used to treat certain types of cancer, particularly acute lymphoblastic leukemia (ALL) and Non- Hodgkin's lymphoma.

How is it administered?

Pegaspargase is an enzyme that breaks down the amino acid asparagine in the body. Cancer cells require asparagine to grow and divide and cannot produce their asparagine. By breaking down asparagine in the body, this medication can effectively "starve" cancer cells of this essential nutrient, slowing their growth and promoting cancer cell death. However, normal cells in the body can produce their asparagine and are not as affected by the enzyme as cancer cells. Therefore, this medicine selectively targets cancer cells while sparing healthy cells in the body to some extent.

Side Effects

Some of the more common side effects of pegaspargase include nausea, vomiting, loss of appetite, fatigue, headache, fever, chills, mouth sores, muscle or joint pain, skin rash or itching, and changes in blood clotting. However, this medication can also cause more serious side effects that require immediate medical attention. These include allergic reactions, liver damage, pancreatitis, blood clots, and high blood sugar.

Warnings

Pegaspargase can cause severe allergic reactions, which can be life-threatening. It can cause inflammation of the pancreas, a condition known as pancreatitis. Symptoms of pancreatitis include severe abdominal pain, nausea, and vomiting. This medication can cause blood clotting, which increases the risk of stroke or heart attack. Sometimes the medication can cause kidney damage and affect the central nervous system, causing symptoms such as confusion, seizures, or difficulty concentrating. The immune system becomes weak with the long-term continuation of treatment which may increase the risk of infection.

Precautions

Several precautions should be taken when using Pegaspargase. First, this medication should not be used in patients who are allergic to it or its components. Patients with pre-existing nerve damage or other conditions that affect nerve function may be at increased risk for nerve damage, and caution should be taken when using this medication in these patients. Patients with pre-existing heart conditions and kidney disease should be closely monitored during treatment. You should avoid contact with people with contagious illnesses and promptly report any signs of infection to your healthcare provider. Patients should be carefully monitored for signs of infection, bleeding, or anemia. Adjustments to the treatment regimen may be necessary to manage side effects and ensure the best possible outcomes.

Word of Advice

Several precautions should be observed when using pegaspargase. This medication must not be used in patients with known allergy to pegaspargase or any of its components. Patients with pre-existing peripheral neuropathy or other conditions affecting nerve function face increased risk of nerve damage; caution is warranted when administering this medication in such patients. Patients with pre-existing cardiac conditions and renal disease require close monitoring throughout treatment. Contact with individuals carrying contagious illnesses should be avoided, and any signs of infection must be reported promptly to your doctor. Patients require careful monitoring for signs of infection, bleeding, or anaemia. Dose adjustments or modifications to the treatment plan may be necessary to manage adverse effects and optimise clinical outcomes.

References

KD Tripathi, Essentials of Medical Pharmacology, Anticancer drugs, 7th edition, 2013, 868 Goodman & Gilman’s, The Pharmacological Basis of Therapeutics, Cytotoxic agents, 12th edition, 2011, 1720 Les Laboratories Servier, Electronic medicines compendium (EMC), [ Revised on Nov 2021] [ Accessed on 25th April 2023], https://www.medicines.org.uk/emc/files/pil.10824.pdf Sigma-Tau Pharmaceuticals, US Food, and Drug Administration, [ Revised on March 2011] [ Accessed on 25th April 2023], https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103411s5126lbl.pdf

Frequently Asked Questions

Can I use pegaspargase if I have kidney disease?

Patients with kidney disease may still be able to use pegaspargase, but caution is needed as the medication can cause kidney toxicity. Dosing and monitoring may need to be adjusted based on the severity of kidney disease.

How will Pegaspargase affect my blood?

Pegaspargase can cause blood clotting disorders, leading to serious or life-threatening bleeding or clotting. Patients should be closely monitored for signs of abnormal bleeding or clotting.

Can pegaspargase be given to patients with a history of pancreatitis?

It depends on the severity and cause of the pancreatitis. Patients with a history of pancreatitis may be at increased risk of experiencing pancreatitis while using Pegaspargase. However, if the benefits of using this medication outweigh the risks, it may sometimes be used with careful monitoring.

How long does the effect of pegaspargase last?

The effect of pegaspargase may last several weeks, depending on the patient's medical condition and response to treatment.

Can I take pegaspargase if I have diabetes?

Patients with diabetes may still be able to use pegaspargase, but caution is needed as the medication can cause glucose intolerance and hyperglycemia. Patients with a history of diabetes should be closely monitored for signs of high blood sugar, such as increased thirst, urination, and fatigue, during treatment.

Available Brands 5

Written By: Muskan Patel, M.Pharm

Reviewed By: Dr. Vishwa Patel, MBBS