Tumor lysis syndrome (TLS) is a potentially fatal oncological emergency caused by rapid tumor cell lysis, leading to metabolic abnormalities such as hyperuricemia, hyperkalemia, and hyperphosphatemia. While traditionally associated with hematologic malignancies, recent reports indicate its occurrence in solid tumors and under new treatments.
Management strategies include prophylactic hydration and pharmacotherapy. Allopurinol, a xanthine oxidase inhibitor, suppresses uric acid production but carries a risk of xanthine accumulation in renal impairment. Febuxostat, a non-purine xanthine oxidase inhibitor, demonstrates superiority in renal impairment and has proven efficacy in preventing TLS. Rasburicase, a recombinant uric acid oxidase, promotes rapid uric acid reduction and is recommended for high-risk cases. The role of febuxostat in TLS management, particularly in hematologic malignancy patients, was evaluated. Significant reductions in serum uric acid levels were observed without serious adverse events, leading to results reflected in insurance coverage for TLS and Japanese guidelines. For rasburicase, which has rapid onset of action, considerations regarding TLS administration strategies were explored, including proposals for combination therapy for optimized treatment.
Further research is needed to evaluate long-term prognosis, enhance understanding of the disease, and develop treatments.
