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High-dose methotrexate with a safe rescue program

D A Decker, J H Edmonson, G S Gilchrist

    Oncology
    |January 1, 1981
    PubMed
    Summary
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    High-dose methotrexate (MTX) infusions for osteogenic sarcoma showed minimal toxicity when combined with leucovorin rescue and fluid alkalinization. Most patients tolerated the treatment well, with few side effects observed during high-dose chemotherapy.

    Area of Science:

    • Oncology
    • Pharmacology
    • Biochemistry

    Background:

    • Osteogenic sarcoma is a rare bone cancer.
    • High-dose methotrexate (MTX) is a chemotherapy drug used to treat various cancers.
    • Effective rescue strategies are crucial to mitigate MTX toxicity.

    Purpose of the Study:

    • To evaluate the safety and efficacy of high-dose MTX with leucovorin rescue in osteogenic sarcoma patients.
    • To assess the relationship between MTX clearance and toxicity.
    • To determine the optimal supportive care for high-dose MTX therapy.

    Main Methods:

    • Observational study of 23 osteogenic sarcoma patients.
    • 142 high-dose MTX infusions (3,000–8,200 mg/m2) over 6 hours.
    • Intravenous leucovorin rescue and continuous alkalinized fluid infusions.

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    Main Results:

    • Only 3 out of 142 MTX infusions resulted in mild cytotoxic side effects.
    • Plasma MTX clearance varied widely (90–600 ml/min).
    • Patients with low MTX clearance experienced mild toxicity, but others with similar clearance had no significant adverse effects beyond nausea.

    Conclusions:

    • High-dose MTX with leucovorin rescue and fluid alkalinization is a well-tolerated regimen for osteogenic sarcoma.
    • MTX clearance is a factor in toxicity, but not the sole determinant.
    • This treatment approach demonstrates a favorable safety profile in managing osteogenic sarcoma.