Q: Which of the following is not yet established as a standard of treatment during the management of Tumor Lysis Syndrome (TLS)?

A) IV Hydration
B) Rasburicase
C) Allopurinol 
D) Febuxostat
E) Dialysis


Answer:  D

 Febuxostat is an excellent selective inhibitor of xanthine oxidase for the management of chronic hyperuricemia in gout. At this given point, data is insufficient to use it during the management of TLS. Another disadvantage is its potential hepatotoxicity.  Febuxostat should only be used where allopurinol or rasburicase cannot be used for any reason. All other choices are well established modalities in the treatment of TLS. Dialysis is required in about 5% of TLS patients. 


References / further reading:

1.Coiffier B, Altman A, Pui CH, et al. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol 2008; 26:2767.

2. Spina M, Nagy Z, Ribera JM, et al. FLORENCE: a randomized, double-blind, phase III pivotal study of febuxostat versus allopurinol for the prevention of tumor lysis syndrome (TLS) in patients with hematologic malignancies at intermediate to high TLS risk. Ann Oncol 2015; 26:2155.

3. Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med 2011; 364:1844.