PRACTICE OF L-ASPARAGINASE USAGE: A SURVEY AMONG HEALTHCARE PROVIDERS
TREATING CHILDREN WITH CANCER IN INDIA
Abstract
Introduction: L‑Asparaginase is an essential chemotherapeutic
agent in the therapy of Acute Lymphoblastic Leukemia (ALL), which has
led to improvement in survival. In low and middle-income countries like
India, the outcomes in ALL are inferior compared to the published
literature, one of the cause of which are believed to be due to the
inferior quality of bioequivalent Asparaginase. The following survey
attempts to understand the practice of using this agent among
oncologists treating children with cancer in our country.
Methods: The researchers designed a structured online
questionnaire comprising 25 aspects of L-Asparaginase usage in the
study. The questionnaire was directed to the healthcare providers
involved in treating children with cancer in India. Results: Of
the total 80 responses recorded, 51 (64%) respondents had more than
five years of experience in pediatric oncology and were treating at
least 5-10 newly diagnosed ALL patients per month. Forty-one (51%)
respondents utilized Native Asparaginase, and 21 (26.3%) oncologists
used PEGylated-Asparaginase exclusively. The most common route of
administration was the intramuscular route (66.3%). Seventy percent of
respondents utilized Native form at a dose of 10,000IU/m
2 and 20% at 6000IU/m 2. The
amounts used for PEGylated L-Asparaginase were 1000IU/m
2, 2500IU/m 2, and variable doses in
48%, 40%, and 10% of responses, respectively. Though Serum
Asparaginase assay (SAA) was not measured routinely in most of the
centres, 39 (48.8%) healthcare providers perceived performing SAA helps
to make the clinical decision. Conclusion: This survey shows a
wide variation in L-Asparaginase usage among healthcare providers caring
for children with cancer in our country. As L-Asparaginase is the
pivotal component of ALL therapy, uniformity in its usage and dosing
with the possibility of monitoring SAA due to the quality of
bioequivalent may be one of the critical steps towards improving
outcomes in ALL in our country.