pegaspargase (Oncaspar, PEG-L-asparaginase)

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: 1) pancreatitis 2) significant hemorrhagic events with prior L-aspariginase therapy Dosage: 1) dosage individualized 2) IM administration may decrease risk of anaphylaxis Injection: (preservative-free) 750 units/mL. Adverse effects: 1) 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 2) less common (> 5%) - rash, erythema, edema, pain, fever/chills, urticaria, dyspnea, bronchospasm - emetic potential mild 3) not common (1-5%) - hypotension, tachycardia, thrombosis, abdominal pain, disseminated intravascular coagulation, decreased fibrinogen, hemolytic anemia, leukopenia, pancytopenia, thrombocytopenia, increased thromboplastin 4) myelosuppression - WBC mild, platelets mild - onset 1 days - nadir 14 days - recovery 21 days 5) adults have some higher incidence of adverse effects than children Drug interactions: 1) methotrexate (may decrease antineoplastic effect if given immediately prior to methotrexate) 2) vincristine (may increase toxicity) 3) prednisone (may increase hyperglycemic effect) 4) may increase bleeding in patients receiving warfarin, NSAIDs, heparin or dipyridamole

General

L-asparaginase (L-asparagine amidohydrolase, asparaginase-like protein 1, ASRGL1, ALP, CRASH) antineoplastic agent (chemotherapeutic agent)

References

Kaiser Permanente Northern California Regional Drug Formulary, 1998