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Rescue from high-dose methotrexate with 5-methyltetrahydrofolate.
Cancer Treatment Reports
|February 1, 1986
Summary
5-methyltetrahydrofolate (MTHF) effectively prevents toxicity from high-dose methotrexate (HDMTX) treatment. This study shows MTHF is a safe and effective rescue agent, comparable to citrovorum factor (CF), even at potentially fatal HDMTX doses.
Area of Science:
- Oncology
- Pharmacology
- Biochemistry
Background:
- High-dose methotrexate (HDMTX) treatment requires rescue therapy to prevent toxicity.
- 5-Formyl-tetrahydrofolate (citrovorum factor, CF) is a standard rescue agent.
- 5-methyltetrahydrofolate (MTHF) is a downstream metabolite of CF, essential for thymidine synthesis.
Purpose of the Study:
- To evaluate the efficacy of MTHF as a rescue agent for HDMTX.
- To assess MTHF's safety profile in patients receiving escalating doses of MTX.
- To compare MTHF rescue with CF rescue.
Main Methods:
- Fifteen patients received 18 courses of escalating-dose MTX (1-24 g) followed by MTHF rescue.
- Toxic effects were monitored.
- A "matched pairs" comparison of CF and MTHF rescue was conducted in five patients.
Main Results:
- MTHF effectively prevented or reversed HDMTX toxicity, including leukopenia, thrombocytopenia, mucositis, nausea, vomiting, and elevated creatinine and transaminase levels.
- All observed side effects were reversible, with full patient recovery.
- MTHF demonstrated comparable rescue efficacy to CF in a "matched pairs" analysis.
Conclusions:
- MTHF is an effective and safe agent for preventing MTX toxicity, even at doses up to 24 g.
- MTHF serves as a viable alternative to CF for methotrexate rescue therapy.