L-Asparaginase is a chemotherapy drug for certain blood cancers. It is marketed as L-Aspara and L-Ginase among others. This medication is indicated for the treatment of Acute Lymphoblastic Leukemia. It is available with a strength of 10,000 IU in the form of injections.

FDA Approval History:

For acute lymphoblastic leukemia: June 30, 2021

Uses

L-Asparaginase is an antineoplastic agent that is covalently conjugated to monomethoxy polyethylene glycol. It is indicated for the treatment of patients diagnosed with:

• Acute Lymphoblastic Leukemia (ALL) as first-line therapy and a component of a multi-agent chemotherapy regimen.
• Acute Lymphoblastic Leukemia and Hypersensitivity to native forms of Asparaginase, as a component of a multi-agent chemotherapeutic regimen.
• Newly diagnosed Acute lymphoblastic lymphoma as a first-line treatment.

Working

L-Asparaginase works by attacking asparagine, a type of amino acid.

STEP-1

Asparagine: Asparagine is an amino acid synthesized by normal cells. All cells need this compound since it is used in the biosynthesis of proteins. Similarly, cancer cells also need asparagine to grow and proliferate.

STEP-2

L-Asparaginase Enters: The antitumor effect of L-Asparaginase leads to the depletion of asparagine and subsequent inhibition of protein synthesis.

STEP-3

Cell Death: Due to the effect of L-Asparaginase, some malignant cells lose the ability to produce asparagine. This leads to cell death due to the loss of exogenous sources of asparagine.

Side Effects

L-Asparaginase may cause side effects that are listed below. Usually, doctors recommend over-the-counter drugs

Common side effects:

• Skin rash
• Hives
• Itching
• Peeling skin
• Chest tightness
• Difficulty in swallowing
• Upset stomach
• Coughing up blood
• Sore throat
• Back pain
• Blurred eyesight
• Abnormal vaginal bleeding
• Hoarseness

Rare side effects:

• Light-colored stools
• Increased urination
• Frequent bruising
• Swelling of the arms
• Difficulty in breathing
• Nausea
• Blistered skin
• Unexplained weight gain
• Blood in the urine
• Dizziness
• Fever and chills

Warnings & Precautions

• Pregnancy
  No animal studies are available in this category of patients. Thus, it’s not known if L-Asparaginase can cause fetal harm to the baby. The oncologist makes the patient aware of the potential risks to avoid later complications.
• Breastfeeding
  Researchers aren’t sure whether this drug gets excreted into breast milk. To not take any risk, the doctor may ask patients to discontinue breastfeeding. That’s because most cancer drugs are expected to excrete into the mother’s milk.
• Geriatric Use
  The clinical trials of L-Asparaginase did not include enough old-age patients. This made it unclear whether those patients respond differently to the drug.
• Thrombosis
  It is a serious condition in which the blood clots block the vessels. Patients experiencing acute shortness of breath, severe headache, or swelling of the leg must be monitored. L-Asparaginase may lead to thrombosis in some patients.
• Pancreatitis
  This condition may occur in certain patients taking the drug. It can cause severe abdominal pain. Pancreatitis is the swelling in the pancreas.
• Glucose Intolerance
  Symptoms like increased urination and thirst may be the indicators of glucose intolerance. Dose adjustment may be required in such a condition.
• Coagulopathy
  Oncologists monitor the coagulation parameters periodically to avoid coagulopathy. It is a kind of serious bleeding disorder.
• Hepatotoxicity
  Patients with severe hepatotoxicity must administer L-Asparaginase with caution. Moderate cases may just require some dose adjustments.

Interactions

To avoid severe interactions, the doctor may ask about the medicines you already administer. This helps the medical team in analyzing the potential interactions. Certain drugs may require dose modifications too.

Interaction with medicines: Drugs that may show severe interactions with L-Asparaginase are adalimumab, cladribine, baricitinib, levoketoconazole, fingolimod, mipomersen, and ponesimod. However, this is not a complete set of medicines. Other drugs can also have an impact on the working of L-Asparaginase.

Interaction with diseases: Diseases that are known to affect the mechanism of L-Asparaginase are listed below. Though some lifestyle diseases like diabetes and high blood pressure may also have an impact.

• Hyperglycemia
• Myelosuppression
• Coagulation abnormalities/bleeding
• Pancreatic dysfunction
• Hepatic dysfunction
• Mental status changes

Interaction with alcohol: Consumption of alcohol during this therapy may increase your chance of liver damage. It is important to consult your doctor to know its other potential risks. All in all, avoid taking ethanol in all forms possible.

Overdose

The recommended dose of L-Asparaginase is 2,500 IU/m2. The drug is administered intravenously (into a vein) or intramuscularly (into a muscle). It is prescribed for use no more frequently than every two weeks. Clinicians recommend dose modifications in patients suffering from severe hepatotoxicity.

As per the clinical trials, three patients were administered a dose of 10,000 IU/m2. Out of the 3, one patient experienced symptoms of increased liver enzymes. The second one got a skin rash and the third did not get any side effects. It is recommended to avoid overdosage of any drug. On experiencing potential overdose symptoms, contact your nearest hospital.

NOTE: Do not take or sell this drug without a prescription. This article is not an alternative to any prescription by a medical professional.