Rasburicase 1.5mg powder and solvent for solution for infusion vials

No systematic synthesis of all cases of spontaneous tumor lysis syndrome (STLS) in adult patients with solid tumors is available to date. Herein, we aim to recognize specific STLS characteristics and parameters related to a worse prognosis. We conducted a systematic search for randomized controlled trials, cohorts, case-control studies, and case reports. The primary endpoints were death and the need for renal replacement therapy (RRT) due to STLS. We estimated crude odds ratios (ORs) with 95% confidence intervals (95%CI) via univariate binary logistic regression. We included one cohort of 9 patients and 66 case reports of 71 patients [lung cancer 15(21.1%)]. Regarding the case reports, most patients [61(87.1%)] had metastatic disease [liver 46(75.4%)], developed acute kidney injury [59(83.1%)], needed RRT [25(37.3%)], and died due to STLS [36(55.4%)]. Metastatic disease, especially in the liver [p = 0.035; OR (95%CI): 9.88 (1.09, 89.29)] or lungs [p = 0.024; 14.00 (1.37, 142.89)], was significantly associated with STLS-related death compared to no metastasis. Cases resulting in death had a significantly higher probability of receiving rasburicase monotherapy than receiving no urate-lowering agents [p = 0.034; 5.33 (1.09, 26.61)], or the allopurinol-rasburicase combination [p = 0.023; 7.47 (1.40, 39.84)]. Patients receiving allopurinol were less likely to need RRT compared to those not receiving it or those receiving rasburicase. In conclusion, current anecdotal evidence demonstrated that metastatic disease, especially in the liver and lungs, may be associated with STLS-related death compared to no metastatic status. Careful surveillance of high-risk cases within larger studies is essential to identify markers predicting morbidity or mortality.

Abstract licence: CC BY

BackgroundTumor lysis syndrome (TLS) in patients with lung cancer (LC) is poorly characterized, due to its predominance in hematologic malignancies, creating a gap in both recognition and management strategies.MethodsWe reviewed the literature to identify features that distinguish patients with lung cancer (LC) at high risk for tumor lysis syndrome (TLS) and poor prognosis, and to evaluate treatment outcomes. The PubMed database was queried through February 2025 in accordance with PRISMA guidelines. Twenty-nine case reports, including clinical courses and biochemical data of LC patients who developed TLS, were analyzed and appraised.ResultsRisk factors for tumor lysis syndrome (TLS) included elevated uric acid and lactate dehydrogenase (LDH) at baseline, along with dyspnea, oliguria, and lethargy. Factors associated with increased mortality included high baseline LDH, symptomatic TLS, the need for renal replacement therapy, liver metastasis, and widespread metastatic disease. Rasburicase was associated with improved survival in a limited subset. Mortality in patients with lung cancer (LC) and TLS rivaled that observed in hematologic malignancies.ConclusionFor patients with high-risk lung cancer (LC), proactive initiation of urate-lowering therapy and hydration along with rasburicase and continued hydration for those who develop tumor lysis syndrome (TLS) may reduce mortality. Further multicenter studies may influence diagnostic criteria, risk assessment, and prophylactic guidelines for TLS to better account for high-risk LC and other solid tumor patients.

Abstract licence: CC BY