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An enzyme that starves leukaemia cells of an amino acid they cannot make; a mainstay of childhood ALL therapy for 50 years, with new versions solving allergy and supply problems.
E. coli asparaginase (1978), pegaspargase (1994; first-line 2006), calaspargase pegol (2018, longer interval) and recombinant Erwinia asparaginase (Rylaze, 2021) after Erwinaze shortages. Asparaginase intensity underlies paediatric-inspired adult ALL regimens. Toxicities: hypersensitivity, pancreatitis, thrombosis, hepatotoxicity, hyperglycaemia; silent inactivation is monitored by asparaginase activity levels.
Backbone ribbon from PDB 3ECA. RCSB PDB 3ECA. The ribbon widens where the chain is folded into a regular pattern and narrows where it is a loose loop.
Depletes plasma asparagine (and glutamine), starving lymphoblasts that lack asparagine synthetase; pegylation extends half-life, Erwinia-derived enzyme avoids cross-reactive hypersensitivity.
1.Asparaginase (pegaspargase, calaspargase pegol, Erwinia asparaginase) binds its target.
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. Pegaspargase (Oncaspar), calaspargase pegol (Asparlas) and Rylaze are clinician-administered Part B drugs; paediatric ALL patients are mostly on commercial family plans or Medicaid.
Covered as part of standard paediatric and adult ALL protocols; Rylaze usually requires documented hypersensitivity to E. coli-derived asparaginase.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
Sources: NICE TA408 · SMC advice: pegaspargase. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
| Region | Year | Indication |
|---|---|---|
| US | 1994 | ALL (pegaspargase, hypersensitivity to native); first line 2006 |
| US | 2018 | ALL in patients 1 month-21 years (calaspargase pegol) |
| US | 2021 | ALL/LBL with hypersensitivity to E. coli asparaginase (Rylaze) |
| EU | 2016 | Oncaspar centralised 2016; Erwinase and native asparaginases national |
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Query for this drug: (TITLE:"Asparaginase" OR ABSTRACT:"Asparaginase" OR TITLE:"pegaspargase, calaspargase pegol, Erwinia asparaginase" OR ABSTRACT:"pegaspargase, calaspargase pegol, Erwinia asparaginase" OR TITLE:"Oncaspar" OR ABSTRACT:"Oncaspar" OR TITLE:"Asparlas" OR ABSTRACT:"Asparlas" OR TITLE:"Rylaze" OR ABSTRACT:"Rylaze" OR TITLE:"Erwinaze" OR ABSTRACT:"Erwinaze") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Asparaginase (pegaspargase, calaspargase pegol, Erwinia asparaginase), not a curated reading list.
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