Extremely delayed elimination of methotrexate in a young man with osteosarcoma: A case study demonstrating an association with impaired renal function
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چکیده
Background: Methotrexate (MTX) is one of the most widely used anti-cancer agents, and administration of high-dose methotrexate followed by leucovorin (LV) rescue therapy is an important component in the treatment of a variety of cancers. High-dose MTX is thought to be safe for administration in patients with normal renal function with concomitant alkalinization, hydration, and pharmacokinetically-guided leucovorin rescue. However, acute renal failure and other adverse outcomes are unavoidable under certain circumstances. High-dose methotrexate (HDMTX)induced renal dysfunction can be a life threatening event, because it delays methotrexate excretion, thereby exacerbating the other toxicities of MTX. High-dose methotrexate -induced renal dysfunction continues to occur in patients with osteosarcoma who are treated on clinical protocols despite optimal supportive care. Approximately, 1.8% of patients with osteosarcoma, who received HDMTX may develope nephrotoxicity of various grade carring considerable mortality rate . High-dose methotrexate-induced renal dysfunction can be life threatening, because it delays methotrexate excretion, thereby exacerbating the other toxicities of methotrexate. HDMTX-induced nephrotoxicity has been usually managed with high-dose leucovorin, dialysis-based methods of MTX removal, thymidine, and recently by adminstration of the recombinant enzyme, carboxypeptidase-G2 (CPDG2), which cleaves MTX to inactive metabolites. Objective: The aim of this paper is to describe the case of an adult Caucasian male patient with osteosercoma who presented with extremely delayed MTX clearance after high-dose administration conducted according to the EURAMOS protocol. In the presnt case, We discuss also the fate of the patient where delayed MTX excretion was a big challenge and finally managed using supportive measures including high doses of leucovorin and very effectively CPDG2 without having to adopt other invasive procedures like dialysis. Keywords—Osteosarcoma,High-doseMXT,
منابع مشابه
Drug-drug interaction between methotrexate and levetiracetam resulting in delayed methotrexate elimination.
OBJECTIVE To report a case of delayed methotrexate (MTX) elimination while receiving concomitant levetiracetam. CASE REPORT A 46-year-old man with relapsed osteosarcoma of the base of the skull receiving high-dose MTX tolerated his first cycle of MTX with elimination to nontoxic MTX levels (≤0.1 µmol/L) within 90 hours. After hospital discharge, the patient experienced seizures secondary to b...
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