Febuxostat is useful for cancer-associated hyperuricemia in patients with hematologic malignancies

Tumor lysis syndrome(TLS)causes hyperuricemia in patients with malignancies under chemotherapeutic treatment. Lowering serum uric acid(S-UA)levels is the most important. Febuxostat has been officially used for chemotherapy-associated hyperuricemia since May 2016 in Japan. Rasburicase and febuxostat reduce S-UA. Rasburicase is effective for high-risk TLS, and febuxostat for low-intermediate risk. Here, febuxostat was evaluated as a treatment for cancer-related hyperuricemia after becoming officially employed for TLS(June 2016 November 2017). Sixty milligram was taken by mouth. The first chemotherapeutic treatment was started within a day after the first 60 mg dosing. The primary endpoint was S-UA normalization(≤ 7 mg /dL)on day 7 of chemotherapy. Twenty-four patients were evaluated(median : 70 years, range : 52-89 years, 14 males /10 females). The baseline S-UA was 7.2±2.7 mg /dL(mean±SD), and S-UA on the 7th day of chemotherapy was 2.5± 1.3 mg /dL(P<0.0001, by paired t-test). All patients met the primary endpoint. In addition, the baseline creatinine was 1.1±0.6 mg /dL(mean±SD), and the value on the 7th day of chemotherapy was 0.8±0.3 mg/dL(P=0.031, by paired t-test). Developing TLS was not observed. Severe adverse reactions were not noted. Thus, 60-mg febuxostat was effective against cancer-associated hyperuricemia. Introduction Tumor lysis syndrome(TLS)occurs in patients with malignancies when the first chemotherapeutic treatment is performed.15) From the cancer cells, purine nucleotides, proteins, phosphorus, and potassium, enter the bloodstream, which results in hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. These conditions may cause renal failure, arrhythmia, and ultimately death. The prevention and the prompt treatment of TLS are crucial. Guidelines and recommendations for the management of TLS have been published.2, 3, 6) There are laboratory and clinical forms of TLS.2, 3, 6) Laboratory TLS is diagnosed when two or more abnormal increases in serum values of uric acid(UA), potassium, or phosphorus are present. Clinical TLS requires, in addition to laboratory TLS, at least one of the followings ; kidney damage, arrhythmias, seizures, or death. The risk of TLS is classified into low受付:2018年2月13日,受理:2018年7月31日 1) Department of Hematology and Oncology 2) Department of Pharmacy, University of Fukui