L-Asparaginase is a type of cancer chemotherapy. It is made from the enzyme called asparaginase from Escherichia coli bacteria. It’s a drug widely used as a part of multi-agent blood cancer therapy. The common brand names of this medicine are L-Ginase and L-Aspara. It belongs to the category of antineoplastic agents. Drugs of this class work by interfering with the function of cancer cells in the body.
This drug is indicated as a part of multi-agent cancer therapy (chemotherapy). Doctors recommend it primarily for the treatment of patients with Acute Lymphoblastic Leukemia. Its recommended dose may depend upon the health history of patients. It lies around 6,000 IU/m2 administered thrice a week. L-Asparaginase injection is made for IM (intramuscular- into a muscle) and IV (intravenous- into a vein) use only.
- Criteria for IM use: The volume must not exceed 2mL per injection site. Doctors can use multiple sites if a greater volume is to be given.
- Criteria for IV use: It must be given for at least 30 minutes as an infusion of either Dextrose or Sodium Chloride injection.
Acute Lymphoblastic Leukemia: It is a type of blood cancer that develops in the bone marrow. The term “acute” indicates that this disease is expected to undergo rapid progression.
When this drug is prescribed for blood cancer treatment, the following conditions are taken into consideration. It is not recommended in the below-mentioned circumstances. If its use can’t be avoided, the patients must be monitored closely during the therapy.
- High blood sugar level
- Low count of red blood cells
- Bleeding disorder
- Pancreatic inflammation
- Low count of white blood cells
- Kidney disease caused by an increase in uric acid
- Joint disorder
- Acute brain disorder
- Abnormal liver function
Clinical Trial Results
Asparaginase treatment reduced plasma asparagine levels in clinical trials in patients with previously untreated, standard-risk ALL from an average of 41 μM to less than 3 μM. This was relevant in those having pre-treatment plasma enzyme activity of higher than 0.1 IU/mL. Asparaginase-treated individuals in this study had their cerebral fluid asparagine levels drop from 2.8 μM (before therapy) to 1.0 μM and 0.3 μM on days 7 and 28 after induction, respectively. Asparagine depletion is caused by native E. coli asparaginase 14 to 23 days after treatment.
Pharmacodynamics & Mechanism
A non-essential amino acid called asparagine supports cell development and the maintenance of DNA, RNA, and protein synthesis. Lymphoblastic leukemia cells lack the asparagine synthetase enzyme and are therefore unable to manufacture asparagine. Whereas healthy cells can get asparagine through food intake or synthesize the amino acid from aspartate through asparagine synthetase activity. Converting L-asparagine from E. coli to L-aspartic acid and ammonia reduces DNA, RNA, and protein synthesis, inhibits cell development, and ultimately activates apoptotic cell-death processes. L-asparagine from E. coli works to deplete plasma levels of asparagine in leukemic cells. However, because normal cells can manufacture their own asparagine, they are less impacted by the asparaginase treatment's quick depletion.
L-Asparaginase with Dexamethasone & Methotrexate
18 patients underwent an assessment of the response rate, of whom 14 were responders with 11 complete responses. 42% showed the lower bound of the one-sided 95% confidence interval for this group. The complete response rate was much lower than the target rate of 20%. One patient only received two cycles of this treatment before passing away from an unrelated cause. Thus, he was not examined after three cycles.
After the first cycle of the L Asparaginase with Dexamethasone & Methotrexate, a 70-year-old man had an outstanding partial response as per the test. He had an extra nasal illness that had advanced after CHOP chemo. One of the four nonresponder patients had stable disease and continued to advance after a year. However, the other three patients’ tumors continued to advance and they eventually passed away. Six of the 14 patients who had reacted after three cycles of treatment relapsed between 1 and 9 months following the end of the course of treatment. This included 2 of the 3 partial responders and 4 of the 11 complete responders. 2 of the 5 patients who got intensive care before relapsing experienced partial remission.
Complications Linked to L-Asparaginase
Like other oncology drugs, this medication can result in various complications. Usually, the doctor makes the patients aware of the same before starting the therapy. Below are some adverse events related to the use of L-Asparaginase.
- Injection-site effects
The use of L asparaginase injection can result in certain injection-site reactions. These may include swelling or pain, redness on the skin, itching, irritation, dry skin, and unusual bumps on the skin. Though, such reactions usually don’t last for a long period.
- Gastrointestinal side effects
Certain stomach-related effects like constipation, hemorrhoids, abdominal pain, loss of appetite, passing gas, nausea, vomiting, pain in the lower abdomen, loose stools, gastrointestinal bleeding, etc may also occur.
- Serious complications
Some patients may experience vision changes, severe headaches, drowsiness, chest discomfort, high fever that doesn’t go away, and muscle cramps during this therapy. Most of these effects may occur in patients already suffering from certain other diseases.
- Adverse events linked to the bladder
Bladder leakage, cloudy urine, strong-selling urine, frequent urination, pain during or after urination, blood in the urine, and painful sexual intercourse might occur due to the administration of this drug.
- Signs of hypersensitivity
Experts believe that L asparaginase is usually discontinued in patients due to the hypersensitivity it may cause. The signs may include dry mouth, flaky skin, pink-colored rashes, fever, swelling on the face, swollen glands, abnormal blood cell counts, and swollen lymph nodes.
- Effects with unknown incidence
These include conditions like seizures, coma, fainting, confusion, high cholesterol, low platelet count, and difficulty in breathing. Some of these reactions are also linked to overdose on this drug.
NOTE: It is important to contact a health practitioner to know the risks & potential benefits of the drug. This content is not for influential purposes. We encourage you not to sell or purchase such cancer medicines unless prescribed by the doctor.