Febuxostat administration for the prevention of tumour lysis syndrome: A meta‐analysis

Abstract

Summary What is known and objective Tumour lysis syndrome is an oncological emergency, characterized by rapid cytolysis leading to an abrupt rise of serum uric acid levels. The aim of the present meta‐analysis is to evaluate the efficacy and safety of febuxostat as a preventive measure in patients at risk of tumour lysis syndrome development, by comparing it with allopurinol administration. Methods MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov and Google Scholar databases were searched from inception to 15 December 2018. All studies evaluating the effectiveness of febuxostat in preventing tumour lysis syndrome were held eligible. Results and Discussion Six studies were included with a total of 658 patients. Compared to allopurinol, febuxostat achieved a similar response rate (OR: 1.39, 95% CI: [0.55, 3.51]) and tumour lysis syndrome incidence (OR: 1.01, 95% CI: [0.56, 1.81]). Serum uric acid levels did not differ between the investigated groups at the second (MD: −0.21 mg/dL, 95% CI: [−1.30, 0.88]) and seventh (MD: −0.43 mg/dL, 95% CI: [−1.38, 0.51]) day of treatment. Elevation of liver function tests was the most common adverse effect, although its incidence was similar among patients treated with allopurinol and febuxostat. What is new and conclusions The present meta‐analysis suggests that febuxostat may serve as an effective alternative to allopurinol in the prevention of tumour lysis syndrome. Future large‐scale studies should define the optimal febuxostat dosage, explore the most appropriate population for its administration and better define its safety profile.

The Roles of ROS Generation in RANKL-Induced Osteoclastogenesis: Suppressive Effects of Febuxostat

“…Febuxostat is a well-known drug for the reduction of uric acid production and is widely used in patients with hyperuricemia or gout [33]. Recently, febuxostat has been approved for prevention of tumor lysis syndrome in cancer patients receiving chemotherapies [34,35]. Despite its clinical application for the prevention of tumor lysis syndrome in cancer patients, little is known about the effects of febuxostat on cancer growth and pathological conditions related to cancers.…”

Onconephrology: The intersections between the kidney and cancer

“…In addition, patients at high risk for TLS should receive a xanthine oxidase inhibitor (allopurinol or febuxostat) to blunt de novo formation and increases in the concentration of uric acid by blocking the conversion of hypoxanthine and xanthine to uric acid. 39 These drugs should be started 2 or 3 days before the initiation of therapy. Urinary alkalinization, which increases the solubility of uric acid in the renal tubules, is not recommended because it can increase the likelihood of calcium-phosphate precipitation and symptomatic hypocalcemia.…”

“…Hydration will also maintain tubular flow rates that facilitate clearance and dilution of uric acid as well as the clearance of potassium and phosphate. In addition, patients at high risk for TLS should receive a xanthine oxidase inhibitor (allopurinol or febuxostat) to blunt de novo formation and increases in the concentration of uric acid by blocking the conversion of hypoxanthine and xanthine to uric acid 39 . These drugs should be started 2 or 3 days before the initiation of therapy.…”

Prevention and Treatment of Tumor Lysis Syndrome in the Era of Onco-Nephrology Progress

“…The drug is usually started 24 h before chemotherapy and discontinued after the risk of TLS is minimal or absent. In a recent meta-analysis which included 6 studies with a total of 659 patients, febuxostat achieved a similar response rate, TLS incidence, and the rate of adverse events when compared to allopurinol [77]. However, the drug is not free from side effects, the most serious being Stevens-Johnson syndrome, anaphylaxis, and, as suggested by a recent safety trial, an increased risk of cardiac and all-cause mortality [78].…”