Rescue after high-dose methotrexate therapy in osteosarcoma

Rescue after High-dose Methotrexate Therapy in Osteosarcoma

Osteosarcoma, a cancerous bone tumor, is a cancer that often requires high-dose methotrexate (MTX) therapy—a chemotherapy drug used to treat various types of cancers—to be effective. MTX can lead to potentially severe side effects including liver, kidney, and bone marrow toxicity, which can significantly limit treatment options and be challenging for patients.

In recent years, the use of “rescue” therapy after high-dose MTX has been successful in many patients with osteosarcoma. Rescue therapy is a process that helps reduce the side effects of MTX therapy and includes various medications and supportive strategies to increase the patient’s tolerance for MTX. The goal of rescue therapy is to help patients safely complete their high-dose MTX regimen.

There are several approaches to rescue after high-dose MTX therapy that can be used in osteosarcoma patients. Here are some of the common methods:

• Hydration: Hydration is essential to help reduce kidney toxicity, one of the side effects of MTX therapy. Patients should be given intravenous fluids prior to their MTX administration, as well as advised to drink plenty of fluids throughout treatment.
Folic acid supplementation: Low levels of folic acid may increase the risk of MTX toxicity and even death. Therefore, supplementation with folic acid is advised for all patients undergoing high-dose MTX therapy.
• Leucovorin: Leucovorin is a form of folate that can be given to help reduce MTX toxicity and reduce the risk of death. It is often used as part of a “rescue” regimen for osteosarcoma patients.
• Antibiotics: Antibiotics are often used in conjunction with MTX therapy to help reduce the risk of infection.
• Granulocyte-colony stimulating factor (G-CSF): G-CSF is a drug that promotes the production of neutrophils, a type of white blood cell important for protecting the body against infection. G-CSF can help reduce the risk of infection associated with MTX therapy.

Rescue after high-dose MTX treatment is an important part of any osteosarcoma therapy plan. With careful monitoring, supportive therapy, and effective medication, patients can benefit from a successful recovery after MTX therapy.