Asparaginase Erwinia chrysanthemi (Erwinaze)

Drug type

• Contains an asparaginase-specific enzyme derived from Erwinia chrysanthemi.

• L-asparaginase is a tetrameric enzyme consisting of four identical subunits, each having a molecular weight of about 35 kDa.

• Activity is expressed in terms of International Units (IU).

Indications

• A component of a multiagent chemotherapeutic regimen for treatment acute lymphoblastic leukemia (ALL) in patients with a hypersensitivity to Escherichia coli-derived asparaginase.

Mechanism of action

• Catalyzes the deamidation of asparagine to aspartic acid and ammonia, resulting in reduced circulating levels of asparagine.

• Mechanism of action may be based on inability of leukemic cells to synthesize asparagine due to lack of asparagine synthetase activity

• Result is cytotoxicity specific for leukemic cells that depend on an exogenous source of the amino acid asparagine for their protein metabolism and survival

Dosage and administration

• To substitute for a dose of pegaspargase:

— Recommended dose is 25,000 IU/m² administered intramuscularly three times a week (Monday/Wednesday/Friday) for six doses for each planned dose of pegaspargase

• To substitute for a dose of native E coli asparaginase:

— Recommended dose is 25,000 IU/m² administered intramuscularly for each scheduled dose of native E coli asparaginase within a treatment.

• Limit the volume administered to 2 mL per injection site. If required dose is more than 2 mL, use multiple injection sites.

Pregnancy and lactation

• Pregnancy category C

• Lactation: not known if distributed in breast milk

— Use caution

Cautions

• Serious hypersensitivity reactions, including anaphylaxis

• Pancreatitis

• Glucose intolerance

• Thrombosis and hemorrhage

Adverse effects

• Most common adverse reactions (incidence >1%):

— Abnormal transaminases

— Coagulation abnormalities including thrombosis and hemorrhage

— Hyperglycemia

— Nausea and vomiting

— Pancreatitis

— Serious hypersensitivity reactions, including anaphylaxis

Drug interactions

— No formal drug interaction studies have been performed.

What to tell your patient

• This medication, asparaginase Erwinia chrysanthemi, is used along with other chemotherapy agents to treat acute lymphoblastic leukemia (ALL).

• It is indicated for patients who have developed a hypersensitivity to asparaginase and pegaspargase, which are made with a protein taken from the bacterium E coli. Asparaginase Erwinia chrysanthemi is made with a different protein, from the bacterium Erwinia chrysanthemi.