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Delayed High-dose Methotrexate Excretion and Influencing Factors in Osteosarcoma Patients

BACKGROUND: High-dose methotrexate (HD-MTX) with folinic acid (leucovorin) rescue is “gold standard” therapy for osteosarcoma. Plasma concentrations of methotrexate (MTX) are closely related to its efficacy and toxicity. Delayed excretion of MTX can lead to serious adverse reactions that may result...

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Autores principales: Zhang, Wei, Zhang, Qing, Zheng, Ting-Ting, Zhen, Jian-Cun, Niu, Xiao-Hui
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125329/
https://www.ncbi.nlm.nih.gov/pubmed/27779157
http://dx.doi.org/10.4103/0366-6999.192781
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author Zhang, Wei
Zhang, Qing
Zheng, Ting-Ting
Zhen, Jian-Cun
Niu, Xiao-Hui
author_facet Zhang, Wei
Zhang, Qing
Zheng, Ting-Ting
Zhen, Jian-Cun
Niu, Xiao-Hui
author_sort Zhang, Wei
collection PubMed
description BACKGROUND: High-dose methotrexate (HD-MTX) with folinic acid (leucovorin) rescue is “gold standard” therapy for osteosarcoma. Plasma concentrations of methotrexate (MTX) are closely related to its efficacy and toxicity. Delayed excretion of MTX can lead to serious adverse reactions that may result in treatment cessation, irreversible organ damage, and death. This study focused on the incidence of delayed excretion of MTX in Chinese osteosarcoma patients. METHODS: A total of 1277 osteosarcoma patients were treated with HD-MTX chemotherapy (4291 cycles) from 2010 to 2015. Factors that could influence delayed excretion of MTX (gender, age, number of chemotherapy cycles, and serum concentration of MTX) were analyzed. RESULTS: The incidence of delayed excretion of MTX (serum concentrations at 24 h [C(24 h)] >5 μmol/L) and severe delayed excretion of MTX (C(24 h) >20 μmol/L) were 6.19% and 0.86% per patient, and 2.31% and 0.26% per cycle of treatment, respectively. The incidence of severe delayed excretion of MTX was associated with gender, age, and C(24 h). CONCLUSIONS: Precaution of delayed excretion of MTX is needed during osteosarcoma treatment using HD-MTX. An optimal individualized rescue strategy can be created with consideration of gender, age, and C(24 h).
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spelling pubmed-51253292016-12-09 Delayed High-dose Methotrexate Excretion and Influencing Factors in Osteosarcoma Patients Zhang, Wei Zhang, Qing Zheng, Ting-Ting Zhen, Jian-Cun Niu, Xiao-Hui Chin Med J (Engl) Original Article BACKGROUND: High-dose methotrexate (HD-MTX) with folinic acid (leucovorin) rescue is “gold standard” therapy for osteosarcoma. Plasma concentrations of methotrexate (MTX) are closely related to its efficacy and toxicity. Delayed excretion of MTX can lead to serious adverse reactions that may result in treatment cessation, irreversible organ damage, and death. This study focused on the incidence of delayed excretion of MTX in Chinese osteosarcoma patients. METHODS: A total of 1277 osteosarcoma patients were treated with HD-MTX chemotherapy (4291 cycles) from 2010 to 2015. Factors that could influence delayed excretion of MTX (gender, age, number of chemotherapy cycles, and serum concentration of MTX) were analyzed. RESULTS: The incidence of delayed excretion of MTX (serum concentrations at 24 h [C(24 h)] >5 μmol/L) and severe delayed excretion of MTX (C(24 h) >20 μmol/L) were 6.19% and 0.86% per patient, and 2.31% and 0.26% per cycle of treatment, respectively. The incidence of severe delayed excretion of MTX was associated with gender, age, and C(24 h). CONCLUSIONS: Precaution of delayed excretion of MTX is needed during osteosarcoma treatment using HD-MTX. An optimal individualized rescue strategy can be created with consideration of gender, age, and C(24 h). Medknow Publications & Media Pvt Ltd 2016-11-05 /pmc/articles/PMC5125329/ /pubmed/27779157 http://dx.doi.org/10.4103/0366-6999.192781 Text en Copyright: © 2016 Chinese Medical Journal http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Zhang, Wei
Zhang, Qing
Zheng, Ting-Ting
Zhen, Jian-Cun
Niu, Xiao-Hui
Delayed High-dose Methotrexate Excretion and Influencing Factors in Osteosarcoma Patients
title Delayed High-dose Methotrexate Excretion and Influencing Factors in Osteosarcoma Patients
title_full Delayed High-dose Methotrexate Excretion and Influencing Factors in Osteosarcoma Patients
title_fullStr Delayed High-dose Methotrexate Excretion and Influencing Factors in Osteosarcoma Patients
title_full_unstemmed Delayed High-dose Methotrexate Excretion and Influencing Factors in Osteosarcoma Patients
title_short Delayed High-dose Methotrexate Excretion and Influencing Factors in Osteosarcoma Patients
title_sort delayed high-dose methotrexate excretion and influencing factors in osteosarcoma patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125329/
https://www.ncbi.nlm.nih.gov/pubmed/27779157
http://dx.doi.org/10.4103/0366-6999.192781
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