Researchers have identified an optimal pegaspargase dosing regimen for the treatment of adult acute lymphoblastic leukemia using up to six intravenous 2,000 IU/m2-doses given at 4-week intervals and synchronized with other chemotherapy drugs to avoid overlapping toxicities.
Of 51 adults with newly diagnosed acute lymphoblastic leukemia who were treated with some or all of six doses, 49 (96%) achieved remission – most within 4 weeks – and the 7-year disease-free and overall survival were 58% and 51% respectively, according to a study published in the March 20 issue of the Journal of Clinical Oncology (doi:10.1200/JCO.2013.50.2708).
Dr. Dan Douer of Memorial Sloan-Kettering Cancer Center, New York, and his colleagues reported that there were no pegaspargase-related deaths, with the most common grade three or four toxicities being hyperbilirubinemia (31.3%), transaminitis (62.7%), hyperglycemia (33.3%), and hypertriglyceridemia (17.6%), and the most serious being pancreatitis (13.7%) and anaphylaxis (5.9%).
Pegaspargase is standard in the treatment of pediatric acute lymphoblastic leukemia but is used sparingly in adults because of its potential higher toxicity, however in this study, the drug was discontinued in only 20% of patients after serious pegaspargase-related toxicity.
Dr. Douer declared honoraria and research funding from Sigma Tau Pharmaceuticals, which supported the study with a research grant.