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Dexamethasone increases hepatotoxicity of MTX in children with brain tumors
1Department of Pediatric Oncology, Alberta Children's Hospital, Calgary, Canada. johannes.wolff@crha-health.ab.ca
Background:
In the treatment of children with brain tumors, dexamethasone and methotrexate are often utilized simultaneously. As previously shown, dexamethasone can reduce the efficacy of methotrexate in vitro (Anticancer Res. 14: 1585-8). Consequently, DEX has been avoided during high dose methotrexate infusions in a pilot study.
Methods:
Side effects of methotrexate with dexamethasone (N = 33) were retrospectively compared with the side effects of methotrexate without dexamethasone (N = 24).
Results:
No serious brain edema in any of the groups was observed; there was no difference in bone marrow toxicity, or mucositis. Liver enzymes, however, were significantly higher when methotrexate was given with dexamethasone: GOT [glutamate oxalacetate transaminase] 76 +/- 73 versus 19 +/- 12, GPT (glutamate pyrovate transaminase) 140 +/- 199 versus 39 +/- 31 IU/I (P < 0.01). This higher hepatotoxicity was not related to differences in methotrexate serum-levels.
Conclusions:
Dexamethasone can be eliminated from high dose methotrexate protocols for children.
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