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Hemoperfusion for methotrexate removal.

T P Gibson, S D Reich, F A Krumlovsky

    Clinical Pharmacology and Therapeutics
    |March 1, 1978
    PubMed
    Summary
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    Amberlite XAD-4 hemoperfusion temporarily lowered methotrexate levels in a breast cancer patient. However, charcoal hemoperfusion demonstrated superior methotrexate removal in vitro, with rebound concentrations expected post-treatment.

    Area of Science:

    • Pharmacology
    • Oncology
    • Biomedical Engineering

    Background:

    • Methotrexate (MTX) is a chemotherapy agent used for metastatic breast carcinoma.
    • High-dose MTX can lead to toxicity, necessitating methods for its removal.
    • Hemoperfusion is a potential extracorporeal technique for drug clearance.

    Observation:

    • Amberlite XAD-4 hemoperfusion was applied to a patient with metastatic breast carcinoma.
    • Plasma MTX concentrations decreased from 5.5 x 10(-7) M to 3.1 x 10(-7) M during 4 hours of hemoperfusion.
    • Plasma MTX clearance by the hemoperfusion device declined from 79 ml/min to 28 ml/min over the treatment period.

    Findings:

    • Amberlite XAD-4 hemoperfusion resulted in a transient reduction of plasma methotrexate.
    • Post-hemoperfusion, plasma MTX concentrations rebounded due to multicompartmental pharmacokinetics.

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  • In vitro studies indicated that uncoated charcoal exhibited greater MTX clearance than Amberlite XAD-4 and artificial kidneys.

    • Implications:

    • Amberlite XAD-4 hemoperfusion offers a temporary measure for reducing plasma methotrexate levels.
    • Charcoal hemoperfusion appears more effective for MTX removal compared to XAD-4.
    • Understanding MTX pharmacokinetics is crucial for managing post-hemoperfusion rebound concentrations.