Pegaspargase (Intramuscular, Intravenous)

Pegaspargase is an antineoplastic medication used as part of an overall treatment plan for patients with acute lymphocytic leukemia, especially those who are allergic to other treatments.

Overview

As a part of a cancer treatment plan, pegaspargase starves cancer cells of a specific type of amino acid until they are dead. This drug is often used in combination with other medications to treat patients who have been diagnosed with first line acute lymphocytic leukemia (ALL), as well as in later stages. It is also used to treat allergic reactions in patients who are being treated with asparaginase, which is another medication used to treat this form of cancer.

This medication is administered by a medical profession as an injection into muscle, or intravenously in a doctor's office or the outpatient clinic within a hospital.

Brand names or other names:

  • Oncaspar

Conditions Treated

  • First line acute lymphocytic leukemia

Type(s) of Medication

  • Antineoplastic

Side Effects

While side effects (or adverse reactions) sometimes occur while you are being treated for a specific medical condition, they do not always happen to everyone who is taking the medication. Whether the effects are severe or mild, rare or common, you should always talk to your doctor if you believe you are experiencing them.

Some adverse reactions to pegaspargase are less harmful than others and may resolve on their own as you continue treatment. If they become severe or do not seem to go away, talk to your doctor. These side effects include:

  • Abdominal or stomach pain

Other side effects are less common, and you should talk to your doctor if you experience them. These effects include:

Severe allergic reactions can sometimes occur with use of this medication. If you see or experience symptoms as a dose is being administered or afterward, seek medical intervention immediately. Symptoms of a severe allergic reaction include:

  • Trouble breathing

In some cases, pegaspargase causes or worsens a case of diabetes by raising your blood sugar. If you are experiencing symptoms of high blood sugar while using this drug, tell your doctor right away, so they can make adjustments to your diabetes medication, diet or exercise program.

The primary symptoms of high blood sugar are increased feeling of thirst and more frequent urination.

Sometimes pancreatitis, or inflammation of the pancreas, can also develop as you are given this medication. Talk to your doctor if you experience symptoms of this condition while you are undergoing treatment. Symptoms of pancreatitis include:

  • Sudden and severe pain in the stomach area

Use of pegaspargase can also increase your risk of developing serious blood clots. If you experience symptoms, let your doctor know immediately. Symptoms of a blood clot include:

There is a slight risk of overdose while you are on this drug. If you find yourself experiencing a rash, get in contact with your local poison control center. If someone you know is using this drug as part of their ALL treatment plan collapses or is not breathing, call your local emergency services number immediately.

There may be other side effects that are not already listed. If you believe you are experiencing an effect that has not been mentioned, tell your doctor what it is, how severe it is and how long it has been happening.

Dosage

Pegaspargase is a liquid treatment that is administered in order to treat ALL, either by injection into muscle or by an intravenous infusion into a vein that takes place for anywhere between 1-2 hours. It is given to the patient by a doctor or a nurse within the confines of a medical office or a hospital's outpatient clinic.

As with other drugs, the manufacturers of pegaspargase include recommended doses for children between the ages of 1-18 and adults undergoing treatment for ALL. For this medication, the manufacturers recommend 2,500 international units/m2 be administered by injection or IV every two weeks or longer.

For intramuscular injections, doctors and nurses should inject no more than 2 ml into any one spot. If the dosage amount specified is more than 2 ml at a time, they will need to locate other injection sites in order to finish administering the dose.

In the case of IV delivery, the doctor or nurse administering the medication will dilute the pegaspargase solution in 100 ml of sodium chloride or 5% dextrose injection. They will give it through an infusion that is already running, immediately after diluting it.

The patient's specific schedule for being given doses and the amount of each dose will be determined by their doctor. The schedule and amount of pegaspargase used depends on the patient's body size and how they are responding to treatment.

Doctors should be cautious about using this medication with patients who are less than one year old, as the safety and efficacy of this medication for that age group has yet to be established.

If you miss a dose of pegaspargase, consult with your doctor immediately about the best way to make up for missing it.

Interactions

The use of this medication is intended to kill cancer cells as part of an overall treatment plan for ALL. When it comes into contact with other drugs or medical conditions, its interactions with the body and the cancer cells it is supposed to destroy are often modified in ways that can be detrimental.

Drug Interactions:

Some drugs, whether prescription or over the counter (OTC), are more likely to have interactions with pegaspargase than others. A list of these medications includes:

  • Anti-cancer drugs, like pemetrexed

Food and Drink Interactions:

Currently, there are not any known food or drink interactions with pegaspargase.

Disease Interactions:

There are a few medical conditions that can have interactions with this drug. They include diabetes, pancreatitis and certain blood clotting disorders.

There are other possible interactions with pegaspargase beyond those listed above. Before you start treatment, talk to your doctor about the medications and supplements you are currently taking as well as your diet, exercise routine, and your medical history. This will allow your doctor to adjust your management plan in ways that make it most effective in treating your condition.

Warnings

Before you undergo treatment with pegaspargase, let your doctor know if you are allergic to it, to L-asparaginase or anything else. This drug has inactive ingredients that may cause an allergic reaction or other issues to occur.

Also, before undergoing treatment, discuss your medical history with your doctor. You will especially need to do this if you have a history of severe reactions to L-asparaginase (like pancreatitis, serious thrombosis or serious hemorrhagic events), or diabetes, blood clotting or bleeding disorders, liver disease or pancreatitis.

Tell your doctor about any and all medications (prescription and OTC), vitamins, supplements and herbal products you are taking or plan to take while being treated with this drug.

If your doctor has chosen the intramuscular route of this medication for treatment, let your doctor or nurse know right away if you notice redness, pain or swelling at the injection site. It is possible that some of the pegaspargase seeped out of the vein it was injected into.

One of the effects of pegaspargase is to weaken your body's resistance to illness, so do not schedule any immunizations or vaccinations while you are on it or immediately afterwards without talking to your doctor first. You should also try to avoid contact with anyone you know who has recently been given the oral polio vaccine or the version of the flu vaccine that is inhaled through the nose. Wear a protective face mask around them if avoidance is not possible.

While undergoing treatment with pegaspargase, you may also bleed or bruise more easily. Be careful while using razors, nail cutters, or other objects that cut into things. Also, try to avoid activities like contact sports while you are on this drug.

Pegaspargase can lower your white blood cell count temporarily, as well as lower the number of platelets in your blood. Take the following precautions while on this medication, to reduce your chances of infection or bleeding:

  • Avoid people with infections as much as possible and check in with your doctor if you think you are getting one.

If you have diabetes, be vigilant about checking your blood sugar regularly while on pegaspargase, as it can increase your blood sugar levels. Also, be sure to share the results with your doctor. If you start having symptoms of high blood sugar, talk to your doctor right away.

If you are pregnant, this drug should only be used if there is a clear need to do so. Check with your doctor about the risks and benefits of using it during this period of time.

It is recommended that you do not nurse your infant while on this medication, as there are concerns about the possibility of the drug passing through into breast milk. Consult with your doctor about the potential risks before you start nursing.

Storage Instructions

Because pegasparagase is only administered in a doctor's office or a hospital's outpatient clinic, it will be stored in the office or clinic. Doctors and nurses are advised to not administer the drug if it has been shake or otherwise vigorously agitated, frozen or stored at a room temperature somewhere between 59-77 degrees Fahrenheit (or 15-25 degrees Celsius) for more than 48 hours.

For doses given by IV, medical professionals should store the diluted solution at temperatures between 36 and 46 degrees Fahrenheit (or 2-8 degrees Celsius) for a maximum of 48 hours. Infusion bags should be protected from exposure to direct sunlight. Before using it, it should be checked for cloudiness, particular matter and discoloration. If any of these three things are seen in the solution, it should not be used, and disposed of instead.

This medication is not available for use by patients outside of approved medical facilities.

Disposal Instructions:

The doctor or nurse administering pegaspargase will be responsible for utilizing the proper disposal methods for expired or extra doses of the medication.

Summary

Even though pegaspargase is an effective medication for treating certain forms of cancer, there are a number of risks involved in the use of it. The likelihood of these risks occurring is greater when lines of communication between a doctor and their patient are not as open as they need to be.

Pegaspargase starves cancer cells to death, but it also leaves the person taking it more vulnerable to infections, diabetes, pancreatitis, and blood clotting issues. Other effects, such as digestive issues, lack of energy and dizziness can significantly decrease the patient's ability to perform the day to day tasks they need to complete.

For these reasons, patients need to be open and honest with their doctor about their medical history and any relevant information they know about their family's medical history. There are also many possible interactions that could worsen the patient's medical condition. This makes it equally important for a patient to disclose all of the medications they are taking, as well as the lifestyle choices they have made.

When it is administered correctly and in the right amounts, pegaspargase eradicates cancer cells associated with acute lymphocytic leukemia as part of the overall management plan for treating the condition. ALL is a difficult condition to overcome, but when the patient has the right medical team working together and a solid treatment plan in place, it is possible to do so.