Oncaspar (pegaspargase) is a long-acting prescription injection medicine used for people with a type of blood cancer known as acute lymphoblastic leukemia (ALL). It is also approved specifically for people who have had allergic reactions in the past to other medicines that contain nonpegylated asparaginase.
Oncaspar is given as an injection into a muscle or as an infusion into a vein (IV) by a health care provider in a hospital or clinic setting. It is given as part of a treatment regimen with other chemotherapy medicines.
How Does Oncaspar Work?
Oncaspar works by lowering levels of an amino acid called L-asparagine that cancer cells in acute lymphoblastic leukemia (ALL) need to survive. Leukemia cells cannot make enough L-asparagine on their own and must get it from the blood.
Oncaspar contains an enzyme called L-asparaginase. L-asparaginase breaks down L-asparagine in the blood. If L-asparagine in the blood is broken down, it cannot be used by leukemia cells to make proteins they need to survive. Healthy cells are less affected by the lack of L-asparagine because they can make their own L-asparagine.
Oncaspar is pegylated. This means that the medicine is attached to a compound called polyethylene glycol, or PEG. This helps the medicine stay in the body longer. For Oncaspar, being pegylated allows the L-asparaginase enzyme to be given about once every 14 days.
How Often Will I Receive Oncaspar?
You will receive Oncaspar in a health care setting. Most people will get Oncaspar about every 14 days. Your dose may be adjusted if you have certain side effects. Follow all instructions from your health care provider on when to return for your next injection or IV infusion.
What Should I Expect When I Receive Oncaspar?
You may receive some of the following medicines before your infusion to lower your risk of having an infusion-related reaction.
- Acetaminophen
- An antihistamine, such as diphenhydramine
- An H2 receptor blocker, such as famotidine
While you are getting your injection or infusion, your health care provider will observe you for signs of reactions. Let your health care provider know right away if you have any of the following symptoms during or after receiving your infusion.
- Fever or chills
- Joint or muscle pain
- Redness of your face and neck
- Trouble breathing
- Chest pain
- Hives
- Nausea or vomiting
Your health care provider may slow down the rate of the infusion, pause the infusion, or stop the medicine if you have any reactions.
What Serious Side Effects Do I Need to Know About?
Angioedema
Let your health care provider know right away if you have any symptoms of angioedema after receiving Oncaspar. Medicines that contain L-asparaginase have caused this allergic-type reaction in some people. Severe angioedema can cause swelling in the following areas of your body.
- Face
- Throat
- Larynx (your voice box)
- Uvula (the little piece of skin that hangs from the back of your throat)
- Arms
- Hands
- Legs or feet
Swelling can also happen in your genitals or intestines, which may cause stomach pain. If you are having a hard time breathing, you need to get help right away.
Pancreatitis
Some people who were treated with Oncaspar got pancreatitis. Let your health care provider know right away if you have any symptoms of pancreatitis, which may include the following.
- Moderate to serious pain in the upper left part of your belly
- Pain that wraps around to your back like a band
- Nausea and vomiting
- Shortness of breath
- A fast heart rate
- Fever
- Low blood pressure
- Bleeding (bruises or nosebleeds)
Your health care provider will likely draw blood to measure your levels of two digestive enzymes: amylase and lipase. People with pancreatitis usually have high levels of these enzymes in their blood. Your health care provider may stop treatment with Oncaspar if you get pancreatitis.
Blood clots
Some people who received L-asparaginase treatments got thrombosis, or blood clots. Let your health care provider know right away if you have any of the following symptoms.
- Trouble speaking
- Vision problems
- Seizures
- Sudden or severe headache
- Weakness on one side of the body
- Arm or leg swelling
- Shortness of breath
- Chest pain
Your health care provider may stop treatment with Oncaspar if you have thrombosis.
Liver disease
Liver damage, called hepatotoxicity, happened in some people treated with Oncaspar. Oncaspar may also increase the risk for blocked blood vessels in the liver, which can be life-threatening. Your health care provider may draw blood to measure liver enzymes. Let your health care provider know right away if you have any of the following symptoms.
- Jaundice
- Sudden weight gain
- Swelling in the stomach
- Pain or tenderness in the right upper part of the stomach
Your health care provider may stop treatment with Oncaspar if you have severe liver damage.
Bleeding
Let your health care provider know if you have any unusual bleeding or bruising while using Oncaspar or if you have any of the following symptoms.
- Pink, red, or brown urine (pee)
- Vomit with blood that looks like coffee grounds
- Red or black stools (looks like tar)
- Coughing up blood clots
Blood sugar
Some people who take Oncaspar can develop hyperglycemia, or increased blood sugar. Your blood glucose level should be checked regularly while you are getting Oncaspar. Tell your health care provider if you have the following symptoms of high blood sugar.
- Thirsty more than usual
- Peeing more than usual
- Increase in hunger
- Tiredness
- Feeling sick to your stomach
- Confusion
- Your breath smelling fruity
Increase in triglycerides
Oncaspar may cause increases in the amount of triglycerides in your blood. Ways to lower your triglycerides include the following.
- Getting more exercise or physical activity
- Trying to lose weight if you have obesity or overweight
- Choosing healthier food that is low in trans fat and cholesterol and high in monounsaturated and polyunsaturated fats
- Reducing the amount of alcohol that you drink
How Was Oncaspar Studied for Acute Lymphoblastic Leukemia?
First-line treatment for ALL
Oncaspar was studied in 118 children with ALL. People in this study received either Oncaspar or another nonpegylated form of asparaginase. Oncaspar was given on day 3 of the first four-week chemotherapy treatment (induction therapy). After that, it was given on day 3 of each of two, eight-week, delayed intensification chemotherapy phases. Delayed intensification is when people get stronger chemotherapy again after the first few rounds of treatment. The nonpegylated asparaginase medicine was given three times a week for nine doses during induction and for six more doses during the delayed intensification chemotherapy phases.
Across both treatment groups, about 36% of the children in this study were between the ages of 6 and 9 years. About 37% were between three and five years of age and 26% were between one and two years of age. About 54% were male, 65% were White, and about 35% were non-White.
To see if Oncaspar worked, researchers looked at the amount of asparagine that was in the blood. The amount of asparagine that was present in the blood was similar between the two treatment groups at certain time points. This means that both medicines were working as they were supposed to to lower the amount of asparagine in the blood.
Use in people with a prior allergic reaction to asparaginase
Four studies looked at use of Oncaspar in people with ALL who had a relapse (the cancer had come back) and had a history of an allergic reaction to other asparaginase medicines that were non-pegylated. About 50% of people had a re-induction response rate, which is how well a medicine works when it is given again after the treatment does not work or the cancer comes back. Of the people who had a response rate, about 36% had complete remission, which is when there is no sign of the cancer on any scan, test, or physical exam, and about 14% had partial remission, which is when the cancer has gotten better but is still there. These rates were similar to the overall response rate in people who received nonpegylated asparaginase.
How Do I Know if Oncaspar Is Working?
You may not see changes right away. It may take weeks to months before your health care provider can tell if Oncaspar is working for you. Your health care provider will consider factors such as blood tests, scans, and symptoms, to know if your ALL is getting better.
Is There Any Cost Assistance Available for Oncaspar?
There may be cost assistance to help you afford Oncaspar. You may have options even if you do not have health insurance. Your healthcare provider can help you get started, or you can call ServierONE at 800-813-5905, Monday through Friday, 8 a.m. to 8 p.m. EST, or email [email protected]. You can also visit www.servierone.com/patient/financial-support/oncaspar.
