Pegaspargase: A Review in Acute Lymphoblastic Leukaemia

Pegaspargase (Oncaspar(®)), a pegylated form of native Escherichia coli-derived l-asparaginase (hereafter referred as E. colil-asparaginase), is indicated in the USA and EU for the treatment of acute lymphoblastic leukaemia (ALL) as a component of multi-agent chemotherapy in paediatric and adult patients. Relative to E. colil-asparaginase, pegaspargase has a prolonged circulation time, thereby offering less frequent administration. Moreover, pegylation of E. colil-asparaginase may diminish the immunogenicity of the enzyme. Based on extensive evidence, intramuscular (IM) or intravenous (IV) administration of pegaspargase as a component of a multi-agent chemotherapy is an effective first-line treatment for paediatric and adult patients with ALL, as well as for the treatment of paediatric and adult patients with ALL and hypersensitivity to E. colil-asparaginase. Pegaspargase had a manageable tolerability profile in paediatric and adult patients with newly diagnosed ALL, with the most commonly occurring adverse events being generally consistent to that seen with E. colil-asparaginase. Pegaspargase treatment in patients with relapsed ALL and hypersensitivity to E. colil-asparaginase had a similar tolerability profile to that observed in patients with newly diagnosed ALL. Given the potentially reduced immunogenicity and more convenient dosage regimen over E. colil-asparaginase, pegaspargase remains an important and effective treatment option for paediatric and adult patients with ALL, including those with hypersensitivity to E. colil-asparaginase. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40265-019-01120-1) contains supplementary material, which is available to authorized users.