handmaid wrote:Potassium (KCl) is an electolyte so the infusion is considered a hydration infusion.
Folate antagonists were among the first antineoplastic agents to be developed. In 1948, aminopterin was used to induce remission in childhood acute lymphoblastic leukemia (ALL), and the related agent methotrexate (MTX) is still an important component of modern treatment for ALL as well as a number of other hematologic malignancies [1]. MTX was the first drug shown to cure a cancer when given as monotherapy, and single agent MTX remains a cornerstone of treatment for malignant gestational trophoblastic disease [2].
The broad range of antitumor activity seen with MTX is reflected in the large number of malignant conditions for which MTX is a component of the treatment regimen (table 1). Furthermore, in addition to antiproliferative activity, MTX also has antiinflammatory and immunomodulating properties, leading to its use in a wide range of doses for a broad range of therapeutic indications across multiple specialties (table 2).
Definition of high-dose MTX — The side effect profile of MTX varies markedly according to dose. Regimens containing MTX are classified as high, intermediate, or low-dose:
amonialogin wrote:Folate antagonists were among the first antineoplastic agents to be developed. In 1948, aminopterin was used to induce remission in childhood acute lymphoblastic leukemia (ALL), and the related agent methotrexate (MTX) is still an important component of modern treatment for ALL as well as a number of other hematologic malignancies [1]. MTX was the first drug shown to cure a cancer when given as monotherapy, and single agent MTX remains a cornerstone of treatment for malignant gestational trophoblastic disease [2].The broad range of antitumor activity seen with MTX is reflected in the large number of malignant conditions for which MTX is a component of the treatment regimen (table 1). Furthermore, in addition to antiproliferative activity, MTX also has antiinflammatory and immunomodulating properties, leading to its use in a wide range of doses for a broad range of therapeutic indications across multiple specialties (table 2).Definition of high-dose MTX — The side effect profile of MTX varies markedly according to dose. Regimens containing MTX are classified as high, intermediate, or low-dose:Most clinicians reserve the term high-dose MTX (HDMTX) for doses ≥500 mg/m2, as are used for central nervous system (CNS) prophylaxis in patients with leukemia and high-risk lymphoma, and for the treatment of leptomeningeal metastases, primary CNS lymphoma, and osteosarcoma. These regimens deliver an otherwise lethal dose of MTX in a 4 to 36 hour infusion, followed by a two to three day period of multiple leucovorin doses to terminate the toxic effect of MTX (termed leucovorin "rescue"). Successful rescue by leucovorin depends on rapid elimination of MTX by the kidneys, which requires aggressive pretreatment as well as posttreatment hydration and urinary alkalinization. The main toxicities of HDMTX are elevated serum transaminase levels and renal insufficiency, which can delay drug clearance.Doses between 50 and 500 mg/m2, as used for malignant gestational trophoblastic disease (GTD), are considered intermediate-dose MTX. In general, these patients do not require aggressive hydration or urinary alkalinization. Leucovorin rescue is rarely needed with doses ≤250 mg/m2 unless unexpected toxicity is encountered. (See "Malignant gestational trophoblastic disease: Staging and treatment", section on 'Methotrexate with and without leucovorin'.)download software