All you need to know about Pegaspargase

What is Pegaspargase?

Pegaspargase (Oncaspar) is used for the treatment of patients with acute lymphoblastic leukemia (ALL).

The pegaspargase is a composition of Oncaspar, which is an enzyme that breaks down asparagine, an essential building block of proteins without which it is difficult to survive for cells. Healthy cells often produce asparagine for themselves, while cancer cells cannot. This medication decreases the level of asparagine in the blood cancer cells and resists the cancerous cells in order to grow.

How does pegaspargase work?

Pegaspargase is specifically involved in breaking down the amino acid asparagine to aspartic acid as well as ammonia. 

The leukemic cells are not able to produce their asparagine and depend on circulating the asparagine for the growth; apart from this, the asparaginase deprives the leukemic cells in order to circulate the asparagine responsible for death of the leukemic cell.

How Oncaspar is given?

Pegaspargase Injection should be administered as an intravenous (IV) infusion over 1-2 hours or maybe given as an intramuscular injection (IM).

Possible side effects: Like all medications, oncaspar can cause side effects, although not everybody gets them.

Very common side effects are as follows:

• Weight loss
• Leg pain
• Chest pain
• Shortness of breath
• Loss of appetite
• General weakness
• Vomiting
• Diarrhoea
• Nausea
• Increased blood sugar levels
• Changes in the function of the pancreas

Common adverse reactions may include:

• Ascites
• Fever and flu-like symptoms
• Mouth sores
• Back, joint or abdominal pain
• High levels of fat
• Increased cholesterol
• Low potassium in blood
• Decreased number of red blood cells

There are some rare pegaspargase side effects, which may include:

• Headache
• Confusion
• Seizures and visual loss 
• Reversible posterior leukoencephalopathy syndrome (RPLS)

warnings and precautions:

Discuss with your doctor prior to receiving pegaspargase. It may inappropriate or not suitable for individuals:

1. If individuals have had serious allergic reactions, for instance itching, flushing or swelling of the airways, because major allergic reactions to this drug may occur.
2. If individuals suffer from a bleeding disorder or have serious blood clots.
3. If individuals get a fever. It may make you comparatively more susceptible to the infections.
4. If individuals have had poor liver function or are taking other medicines which may be harmful for liver. When this drug  is used along with other cancer treatments, liver and central nervous system damage may occur.
5. If individuals suffer from abdominal pain. Inflammation of the pancreas, that in some cases causes death, may develop with pegaspargase injection treatment.
6. This medicine may lead to fluctuations in clotting factors and can increase the risk of bleeding/clotting.
7. If individuals are the parents of a child and are taking treatment with this drug, talk to your doctor if any of the above terms apply to your child.
8. If individuals are pregnant or breast-feeding, or are planning to have a baby, ask your healthcare team for advice prior to using this medication. 

Who should not use Pegaspargase? 

1. Patients who are allergic to pegaspargase or to any of the other ingredients of this medicine.
2. Patients who have severe hepatic disease.
3. Patients who have ever had pancreatitis.
4. Patients who have ever had severe bleeding following asparaginase therapy.
5. Patients who have ever had blood clots following asparaginase therapy.

Inform your doctor in case any of such terms apply to you. In case you are a parent of a child who is taking treatment with pegaspargase, please discuss with your doctor if any of them apply to your child.

If you are given too much Oncaspar: As a healthcare practitioner will administer the oncaspar, it is quite unlikely patients will be given wrong dosage. 

In the event of an accidental drug overdose, patients will be monitored by the healthcare team and treated accordingly.

In case you want to know something on the use of this drug, ask your doctor.

How to store Oncaspar? 

Keep the oncaspar 3750 out of the sight and reach of children. Should be stored in the refrigerator (2°C-8°C).

Freezing of medication is not recommended. Following the medicinal product has been reconstituted and diluted, the solution must be used as soon as possible. If the diluted solution can not be used immediately, it should be stored at 2°C-8°C for up to 48 hours.

NOTE: The information provided in this article is only for informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis, of a qualified healthcare practitioner.

Addition of Pemetrexed and Carboplatin to Gefitinib Doubled PFS in Patients with EGFR-Mutant NSCLC

On behalf of derived outcomes of a randomized phase 3 study came into view in the Journal of Clinical Oncology, adding pemetrexed and carboplatin to gefitinib significantly enhanced the progression free survival and OS for participants with NSCLC and EGFR-sensitizing mutations. 

Although data suggests that the clinically relevant severe toxicities have been observed twice as often with the combination regimen than with gefitinib alone.

According to Vanita Noronha, MD, MBBS, professor in the department of medical oncology at Tata Memorial Hospital in Mumbai, India, and colleagues, “Apart from the detection of molecular target and using medications, believed to bind to the target, cure and long-term remission elude us,” “Resistance inevitably occurs within 8-12 months. Number of ways have been implemented in order to reduce the emergence of resistance. One strategy involved in order to combine the cytotoxic chemotherapy with an EGFR TKI.” She added. 

Between August 2016 and August 2018, in an open-label study conducted by Noronha and colleagues, total 350 participants enrolled with advanced, chemotherapy-naive, EGFR-mutated Non-Small Cell Lung Cancer. About 18% of participants had brain metastases and 21% found with an ECOG performance status of 2.

The investigators differentiated patients on the basis of performance status and EGFR mutation type and randomly assigned them 1:1 to gefitinib 250 mg orally once per day alone (n = 176; median age, 56 years; range, 27-78) or with pemetrexed 500 mg/m2 IV and carboplatin IV area under the curve 5 each 3 weeks for the four cycles (n =174; median age, 54 years; range, 27-75). The combination regimen was followed by maintenance pemetrexed 500 mg/m2 IV every three weeks.

The progression free survival represents as the primary endpoint, and OS, toxicity and RR represent as the secondary endpoints. The researchers specified survival endpoints in the intention in order to treat the population. The median follow-up reported about 17 months.

About 80% of participants treated with gefitinib and chemotherapy, completed all four cycles of pemetrexed and carboplatin. Outcomes represented ORR of about 75.3% among participants in the combination population and 62.5% in the gefitinib-only population. Participants in the combination population had longer median progression free survival than those in the gefitinib-only population. The combination population had significantly longer median overall survival than the gefitinib population.

About 50% of patients in the combination population experienced grade 3 or higher toxicities; maximum because of the chemo induced myelosuppression and nephrotoxicity, compared with 25.3% of those in the gefitinib population.

Researchers have written, “Adding pemetrexed and carboplatin to gefitinib prolonged PFS (progression free survival) and overall survival, but also be responsible for increasing the toxicity."

Also, Jennifer Byrne stated that, "The pemetrexed, carboplatin and gefitinib, together appeared as a new standard first-line therapy for patients with the EGFR-mutant Non-Small Cell Lung Cancer.”