pegaspargase (Oncaspar, PEG-L-asparaginase)

Introduction

Tradename: Oncaspar.

Indications

• acute lymphoblastic leukemia in patients who would benefit from L-asparaginase, but have developed hypersensitivity to native forms of L-asparaginase

Contraindications

• pancreatitis
• significant hemorrhagic events with prior L-aspariginase therapy

Dosage

• dosage individualized
• IM administration may decrease risk of anaphylaxis

Injection: (preservative-free) 750 units/mL.

Adverse effects

• common (> 10%)
  • hypersensitivity
    • anaphylaxis, bronchospasm, dyspnea, urticaria, arthralgia, erythema, induration, pain, tenderness, lip swelling, pancreatitis (may be fulminant & fatal)
  • increased serum amylases & lipase
  • abnormal liver function tests
  • jaundice
  • ascites
  • hypoalbuminemia
  • fatty liver
  • liver failure
• less common (> 5%)
  • rash, erythema, edema, pain, fever/chills, urticaria, dyspnea, bronchospasm
  • emetic potential mild
• not common (1-5%)
  • hypotension, tachycardia, thrombosis, abdominal pain, disseminated intravascular coagulation, decreased fibrinogen, hemolytic anemia, leukopenia, pancytopenia, thrombocytopenia, increased thromboplastin
• myelosuppression
  • WBC mild, platelets mild
  • onset 1 days
  • nadir 14 days
  • recovery 21 days
• adults have some higher incidence of adverse effects than children

Drug interactions

• methotrexate (may decrease antineoplastic effect if given immediately prior to methotrexate)
• vincristine (may increase toxicity)
• prednisone (may increase hyperglycemic effect)
• may increase bleeding in patients receiving warfarin, NSAIDs, heparin or dipyridamole

More general terms

• L-asparaginase
• antineoplastic agent (chemotherapeutic agent)

Additional terms

• asparaginase (Elspar)