Controlling serum uric acid using febuxostat in cancer patients at risk of tumor lysis syndrome

Takai,Mihoko; Yamauchi,Takahiro; Fujita,Kei; Lee,Shin; Ookura,Miyuki; Kishi,Shinji; Urasaki,Yoshimasa; Yoshida,Akira; Iwasaki,Hiromichi; Ueda,Takanori

doi:10.3892/ol.2014.2394

Controlling serum uric acid using febuxostat in cancer patients at risk of tumor lysis syndrome

Authors:
- Mihoko Takai
- Takahiro Yamauchi
- Kei Fujita
- Shin Lee
- Miyuki Ookura
- Shinji Kishi
- Yoshimasa Urasaki
- Akira Yoshida
- Hiromichi Iwasaki
- Takanori Ueda
View Affiliations

Affiliations: Department of Hematology and Oncology, University of Fukui, Matsuoka, Eiheiji, Fukui 910‑1193, Japan, Division of Infection Control, University of Fukui, Matsuoka, Eiheiji, Fukui 910‑1193, Japan
Published online on: July 30, 2014 https://doi.org/10.3892/ol.2014.2394
Pages: 1523-1527

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Tumor lysis syndrome (TLS) is a life‑threatening oncological emergency, in which control of serum uric acid (S‑UA) levels is important. S‑UA‑lowering efficacy of a new xanthine oxidase inhibitor, febuxostat, was retrospectively evaluated in seven patients with hematological malignancies who were at an intermediate risk of developing TLS. A 10‑mg dose of febuxostat was initiated and chemotherapy was started within 24 h of administering the first dose of febuxostat. Febuxostat was continued until at least day 7 of chemotherapy treatment. The UA‑lowering treatment was considered effective if febuxostat reduced S‑UA levels to ≤7.5 mg/dl by day 5. The mean S‑UA level at base line was 6.4±2.6 mg/dl and, on day 5, the mean S‑UA level was 4.7±1.8 mg/dl. All the patients achieved S‑UA levels ≤7.5 mg/dl. Serum creatinine levels decreased from 0.93±0.25 to 0.85±0.25 mg/dl. The estimated glomerular filtration rate values increased from 69.7±24.5 to 76.9±26.2 ml/min. No adverse reactions were noted during the study period and no patients experienced progressive TLS. Successful control of S‑UA and improved renal function were obtained in response to febuxostat treatment in cancer patients at a risk of TLS.

View Figures

View References

1	Cohen LF, Balow JE, Magrath IT, Poplack DG and Ziegler JL: Acute tumor lysis syndrome. A review of 37 patients with Burkitt’s lymphoma. Am J Med. 68:486–491. 1980.
2	Coiffier B, Altman A, Pui CH, Younes A and Cairo MS: Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 26:2767–2778. 2008.
3	Cairo MS, Coiffier B, Reiter A and Younes A; TLS Expert Panel. Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol. 149:578–586. 2010.
4	Howard SC, Jones DP and Pui CH: The tumor lysis syndrome. N Engl J Med. 364:1844–1854. 2011.
5	Firwana BM, Hasan R, Hasan N, Alahdab F, Alnahhas I, Hasan S and Varon J: Tumor lysis syndrome: a systematic review of case series and case reports. Postgrad Med. 124:92–101. 2012.
6	Cairo MS and Bishop M: Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 127:3–11. 2004.
7	Hande KR and Garrow GC: Acute tumor lysis syndrome in patients with high-grade non-Hodgkin’s lymphoma. Am J Med. 94:133–139. 1993.
8	Will A and Tholouli E: The clinical management of tumour lysis syndrome in haematological malignancies. Br J Haematol. 154:3–13. 2011.
9	Massey V, Komai H, Palmer G and Elion GB: On the mechanism of inactivation of xanthine oxidase by allopurinol and other pyrazolo[3,4-d]pyrimidines. J Biol Chem. 245:2837–2844. 1970.
10	Faruque LI, Ehteshami-Afshar A, Wiebe N, Tjosvold L, Homik J and Tonelli M: A systematic review and meta-analysis on the safety and efficacy of febuxostat versus allopurinol in chronic gout. Semin Arthritis Rheum. 43:367–375. 2013.
11	Bruce SP: Febuxostat: a selective xanthine oxidase inhibitor for the treatment of hyperuricemia and gout. Ann Pharmacother. 40:2187–2194. 2006.
12	Schumacher HR Jr, Becker MA, Wortmann RL, et al: Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum. 59:1540–1548. 2008.
13	Edwards NL: Febuxostat: a new treatment for hyperuricaemia in gout. Rheumatology (Oxford). 48:ii15–ii19. 2009.
14	Burns CM and Wortmann RL: Gout therapeutics: new drugs for an old disease. Lancet. 377:165–177. 2011.
15	Garcia-Valladares I, Khan T and Espinoza LR: Efficacy and safety of febuxostat in patients with hyperuricemia and gout. Ther Adv Musculoskelet Dis. 3:245–253. 2011.
16	The guideline revising committee of Japanese Society of Gout and Nucleic Acid Metabolism. Digest of Guideline for the management of hyperuricemia and gout. 2nd edition. Gout Nucleic Acid Metabol. 34. pp. 107–143. 2010, (In Japanese).
17	Cortes J, Moore JO, Maziarz RT, et al: Control of plasma uric acid in adults at risk for tumor Lysis syndrome: efficacy and safety of rasburicase alone and rasburicase followed by allopurinol compared with allopurinol alone-results of a multicenter phase III study. J Clin Oncol. 28:4207–4213. 2010.
18	Kikuchi A, Kigasawa H, Tsurusawa M, et al: A study of rasburicase for the management of hyperuricemia in pediatric patients with newly diagnosed hematologic malignancies at high risk for tumor lysis syndrome. Int J Hematol. 90:492–500. 2009.
19	Yamauchi T, Negoro E, Lee S, et al: A high serum uric acid level is associated with poor prognosis in patients with acute myeloid leukemia. Anticancer Res. 33:3947–3951. 2013.
20	Inai K, Tsutani H and Ueda T: Hyperuricemia associated with hematological malignancies. Gout and Nucleic Acid Metabolism. 23:181–186. 1999.(In Japanese).
21	de Bont JM and Pieters R: Management of hyperuricemia with rasburicase review. Nucleosides Nucleotides Nucleic Acids. 23:1431–1440. 2004.
22	Rampello E, Fricia T and Malaguarnera M: The management of tumor lysis syndrome. Nat Clin Pract Oncol. 3:438–447. 2006.
23	Andreoli SP, Clark JH, McGuire WA and Bergstein JM: Purine excretion during tumor lysis in children with acute lymphocytic leukaemia receiving allopurinol: relationship to acute renal failure. J Pediatr. 109:292–298. 1986.
24	Navolanic PM, Pui CH, Larson RA, et al: Elitek-rasburicase: an effective means to prevent and treat hyperuricemia associated with tumor lysis syndrome, a Meeting Report, Dallas, Texas, January, 2002. Leukaemia. 17:499–514. 2003.
25	Cheson BD and Dutcher BS: Managing malignancy-associated hyperuricemia with rasburicase. J Support Oncol. 3:117–124. 2005.
26	Arellano F and Sacristan JA: Allopurinol hypersensitivity syndrome: a review. Ann Pharmacother. 27:337–343. 1993.
27	Hande KR, Noone RM and Stone WJ: Severe allopurinol toxicity: Description and guidelines for prevention in patients with renal insufficiency. Am J Med. 76:47–56. 1984.
28	Khosravan R, Grabowski BA, Mayer MD, Wu JT, Joseph-Ridge N and Vernillet L: The effect of mild and moderate hepatic impairment on pharmacokinetics, pharmacodynamics and safety of febuxostat, a novel non-purine selective inhibitor of xanthine oxidase. J Clin Pharmacol. 46:88–102. 2006.
29	Becker MA, Schumacher HR, Espinoza LR, Wells AF, MacDonald P, Lloyd E and Lademacher C: The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther. 12:R632010.
30	Vadhan-Raj S, Fayad LE, Fanale MA, et al: A randomized trial of a single-dose rasburicase versus five-daily doses in patients at risk for tumor lysis syndrome. Ann Oncol. 23:1640–1645. 2012.