Rasburicase in Patients at Risk for Tumor Lysis Syndrome
Information source: M.D. Anderson Cancer Center
ClinicalTrials.gov processed this data on August 20, 2015 Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Tumor Lysis Syndrome
Intervention: As Needed Rasburicase (Drug); Fixed Dose Rasburicase (Drug)
Phase: Phase 2
Status: Completed
Sponsored by: M.D. Anderson Cancer Center Official(s) and/or principal investigator(s): Saroj Vadhan-Raj, MD, Principal Investigator, Affiliation: M.D. Anderson Cancer Center
Summary
Primary Objectives:
To determine the efficacy of rasburicase administered as a single dose followed by as needed
dosing (investigational arm) as compared to fixed dosing for 5 days (standard treatment arm)
in the treatment of patients at high risk or potential risk for tumor lysis syndrome.
Secondary Objectives:
1. To evaluate the plasma uric acid area under the curve (AUC) from baseline through 7
days
2. To evaluate the incidence of renal insufficiency and electrolyte abnormalities.
3. To determine the safety and immunogenicity of rasburicase.
4. To evaluate the cost-effectiveness of the experimental treatment (investigational arm).
Clinical Details
Official title: Phase 2 Study of Rasburicase Administered by Two Different Schedules (Fixed Dosing vs. As Needed Dosing) in Patients at High Risk or Potential Risk for Tumor Lysis Syndrome
Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Primary outcome: Number of Participants With Plasma Uric Acid (UA) Response
Detailed description:
The Study Drug and TLS Rasburicase is designed to help decrease or prevent the high level of
uric acid that may occur during the start of chemotherapy. A high level of uric acid in the
blood may lead to decreased kidney function or kidney failure.
TLS occurs when high uric acid levels are caused by breakdown of tumor cells during the
start of chemotherapy. The dead tumor cells can release uric acid and cause other symptoms
of kidney failure, such as releasing large amounts of potassium and phosphorus (chemicals)
into the blood.
Screening Tests Before you can start treatment on this study, you will have "screening
tests." These tests will help the doctor decide if you are eligible to take part in this
study.
Your complete medical history will be recorded. You will have a physical exam, including
measurement of your vital signs (blood pressure, heart rate, temperature, and breathing
rate), height, and weight.
Blood will be drawn (about 2 tablespoons) for routine tests. Women who are able to have
children must have a negative blood (using a sample from the routine blood draw) or urine
pregnancy test.
Study Groups If you are found to be eligible to take part in this study, you will be
randomly assigned (as in the toss of a coin) to 1 of 2 groups. There is an equal chance of
being in either group.
Group A Participants in Group A will receive rasburicase by vein, over 30 minutes, on Day 1
of Cycle 1 of chemotherapy. On Days 1-7 of Cycle 1 of chemotherapy, blood (about 2
tablespoons) will be drawn for routine tests, including a check of the level of uric acid in
your blood. During Days 2-5 of Cycle 1 of chemotherapy, you will only receive rasburicase
(once a day) if the levels of uric acid are high that day.
Group B Participants in Group B will receive rasburicase by vein, over 30 minutes, once a
day from Days 1-5 of Cycle 1 of chemotherapy. On Days 1-7 of Cycle 1 of chemotherapy, blood
(about 2 tablespoons) will be drawn for routine tests, including a check of the level of
uric acid in your blood.
Both Groups Treatment with rasburicase will only be given in Cycle 1 of chemotherapy. The
chemotherapy will be given at least 4 hours (up to 24 hours) after the first dose of
rasburicase.
Length of Study When your blood test results show that you do not have antibodies to
rasburicase, your participation in this study will be over. You will be taken off this
study if the TLS gets worse or intolerable side effects occur.
This is an investigational study. Rasburicase is commercially available, but it is not FDA
approved for treating TLS. It is FDA approved for pediatric patients with leukemia,
lymphoma, and solid tumor cancers who are receiving anti-cancer therapy that is expected to
increase the blood levels of uric acid (the result of cancer cells dying from treatment).
For treating TLS in adult patients, it has been authorized for use in research only. Up to
80 evaluable patients will take part in this study. All will be enrolled at M. D. Anderson.
Eligibility
Minimum age: N/A.
Maximum age: N/A.
Gender(s): Both.
Criteria:
Inclusion Criteria:
1. Patients with hematological malignancies (leukemia/lymphoma) at high risk or
potential risk for tumor lysis syndrome. High risk: hyperuricemia of malignancy (Uric
acid levels >7. 5); diagnosis of very aggressive lymphoma/leukemia based on Revised
European-American Lymphoma (REAL) classification; acute myeloid leukemia, chronic
myelocytic leukemia (CML) in blast crisis; high grade myelodysplastic syndrome only
if they have >10% bone marrow blast involvement and given aggressive treatment
similar to acute myeloid leukemia (AML) (continued on #2)
2. (continued from # 1) Potential risk: diagnosis of aggressive lymphoma/leukemia based
on (REAL) classification. Plus one or more of the following criteria: lactate
dehydrogenase (LDH) >/= 2 x upper limit of normal (ULN); Stage III-IV disease; Stage
I-II disease with at least 1 lymph node/tumor >5cm in diameter.
3. ECOG performance status 0-3
4. Life expectancy >3 months
5. Negative pregnancy test (females of child bearing potential) within =2 weeks of
rasburicase dose and use of efficient contraceptive method (both males and females).
Pregnancy test may be performed on serum (HCG) or urine (HCG)
6. Signed written informed consent (approved by the Institutional Review Board/Ethics
Committee) obtained prior to study entry
Exclusion Criteria:
1. Patient receiving any investigational drug for hyperuricemia within 30 days of
planned first treatment with rasburicase
2. Pregnancy or lactation
3. Known history of significant allergy problem or documented history of asthma or
asthmatic bronchitis
4. Known history of glucose-6-phosphate dehydrogenase deficiency
5. Known history of hemolysis and methemoglobinemia
6. Previous therapy with urate oxidase
7. Other conditions unsuitable for participation in the trial in the Investigator's
opinion
8. Unwillingness to comply with the requirements of the protocol
9. Use of allopurinol within 72 hours of the study entry
Locations and Contacts
UT MD Anderson Cancer Center, Houston, Texas 77030, United States
Additional Information
MD Anderson Cancer Center
Starting date: January 2008
Last updated: May 31, 2013
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