Dinnel Jennifer, Moore Bonny L, Skiver Brent M, Bose Prithviraj
Department of Internal Medicine, Virginia Commonwealth University, VA, USA.
Department of Internal Medicine, Virginia Commonwealth University, VA, USA ; VCU Massey Cancer Center, Richmond, VA, USA.
Core Evid. 2015 Jan 13;10:23-38. doi: 10.2147/CE.S54995. eCollection 2015.
Tumor lysis syndrome (TLS) is a potentially life-threatening complication of cancer therapy characterized by two or more of the following laboratory abnormalities: hyperuricemia, hyperkalemia, hypocalcemia, and hyperphosphatemia, with resultant end-organ damage, eg, renal failure, seizures, or cardiac arrhythmias. High-risk patients include those with highly proliferative cancers and/or large tumor burdens, particularly in the setting of highly effective chemotherapy, among other risk factors. Before 2002, antihyperuricemic drug therapy was limited to allopurinol, a xanthine oxidase inhibitor. Rasburicase, a recombinant urate oxidase, was approved by the US Food and Drug Administration for children in 2002 and adults in 2009, ushering in a new era in TLS therapy. We attempted to critically appraise the available evidence supporting the perceived benefits of rasburicase in the management of TLS. A Medline search yielded 98 relevant articles, including 26 retrospective and 22 prospective studies of rasburicase for the treatment of TLS, which were then evaluated to determine the best available evidence for the effectiveness of rasburicase in terms of disease-oriented, patient-oriented, and economic outcomes. Rasburicase is now a standard of care for patients at high risk of TLS despite continuing debate on the correlation between its profound and rapid lowering of plasma uric acid levels with hard patient outcomes, eg, need for renal replacement therapy and mortality. Rasburicase is dramatically effective in lowering plasma uric acid levels. The mortality and cost-effectiveness benefits of this expensive drug remain to be conclusively proven, and well designed, randomized controlled trials are needed to answer these fundamentally important questions.
肿瘤溶解综合征（TLS）是癌症治疗中一种潜在的危及生命的并发症，其特征为以下两种或更多实验室异常情况：高尿酸血症、高钾血症、低钙血症和高磷血症，并伴有终末器官损害，例如肾衰竭、癫痫发作或心律失常。高危患者包括患有高增殖性癌症和/或肿瘤负荷大的患者，特别是在高效化疗的情况下，以及其他风险因素。2002年之前，抗高尿酸血症药物治疗仅限于黄嘌呤氧化酶抑制剂别嘌醇。重组尿酸氧化酶拉布立酶于2002年被美国食品药品监督管理局批准用于儿童，2009年批准用于成人，开创了TLS治疗的新时代。我们试图严格评估支持拉布立酶在TLS管理中所感知益处的现有证据。一项医学文献数据库搜索产生了98篇相关文章，包括26项关于拉布立酶治疗TLS的回顾性研究和22项前瞻性研究，然后对这些研究进行评估，以确定拉布立酶在以疾病为导向、以患者为导向和经济结果方面有效性的最佳现有证据。尽管对于拉布立酶使血浆尿酸水平迅速大幅降低与患者硬性结局（例如肾脏替代治疗需求和死亡率）之间的相关性仍存在争议，但拉布立酶现在是TLS高危患者的标准治疗方法。拉布立酶在降低血浆尿酸水平方面非常有效。这种昂贵药物的死亡率和成本效益益处仍有待最终证实，需要设计良好的随机对照试验来回答这些至关重要的问题。
