Rasburicase: future directions in tumor lysis management

Acute tumor lysis syndrome (TLS) is an oncologic emergency resulting in several metabolic derangements. Hyperuricemia and its associated complications are the most frequent manifestations of TLS. Crucial to the management is the prompt initiation of a hypouricemic agent such as rasburicase. An established dose of 0.2 mg/kg of rasburicase is effective at decreasing uric acid levels significantly in 4 h of administration and to undetectable levels in 48 h of initiation. The mean uric acid AUC is significantly lower for patients treated with rasburicase when compared to those receiving allopurinol. Rasburicase has demonstrated excellent tolerability and is potentially cost-effective in patients at high risk for TLS. Rasburicase is a safe and effective hypouricemic agent for both adults and children at high risk for TLS and for this reason should be considered the uricolytic agent of choice in these patients.