Systemic high-dose intravenous methotrexate for central nervous system metastases Journal Article
| Authors: | Lassman, A. B.; Abrey, L. E.; Shah, G. D.; Panageas, K. S.; Begemann, M.; Malkin, M. G.; Raizer, J. J. |
| Article Title: | Systemic high-dose intravenous methotrexate for central nervous system metastases |
| Abstract: | Background: Treatment options for patients with recurrent central nervous system (CNS) metastases are limited. Rapid infusion of high-dose intravenous methotrexate (HD IV MTX) penetrates the blood-brain barrier (BBB) and has reported activity in leptomeningeal metastases. Methods: Medical records were reviewed for all patients treated with HD IV MTX (3.5 g/m 2) for CNS parenchymal or leptomeningeal metastases. Radiographic response rate, survival, and toxicity were determined. Results: Thirty-one women and one man with a median age of 52 years (range 33-76) were treated with a total of 141 cycles (median 4, range 1-13). Twenty-nine patients had breast cancer, and one each had cancer of unknown primary (CUP), squamous cell carcinoma of the head and neck, and non-small cell lung cancer (NSCLC). An objective radiographic response and stable disease were each observed in nine patients (28%), and 13 (44%) patients progressed. Prior treatment with low-dose MTX for systemic disease did not affect response (P = 0.8). The median overall survival (n = 32) was 19.9 weeks (range 2.9-135.4+) with one patient alive at 135.4 weeks. Myelosuppression and elevated serum hepatic transaminases were the most common acute toxicities (21% and 9% of HD IV MTX cycles, respectively). Conclusions: HD IV MTX is effective in the treatment of CNS metastases with disease control (response or stable) as a best response in 56% of assessable patients. Further study is warranted. © Springer Science+Business Media, Inc. 2005. |
| Keywords: | adult; clinical article; controlled study; treatment outcome; aged; middle aged; survival analysis; retrospective studies; overall survival; review; squamous cell carcinoma; carcinoma, squamous cell; cancer growth; side effect; liver dysfunction; capecitabine; chemotherapy; methotrexate; drug megadose; thrombocyte; breast cancer; anemia; bone marrow suppression; antimetabolites, antineoplastic; leukopenia; lung non small cell cancer; thrombocytopenia; carcinoma, non-small-cell lung; lung neoplasms; creatinine; hemoglobin; creatinine blood level; kidney failure; dose-response relationship, drug; breast neoplasms; thiotepa; central nervous system; central nervous system neoplasms; alanine aminotransferase blood level; aspartate aminotransferase blood level; drug fever; alanine aminotransferase; aspartate aminotransferase; confusion; hyponatremia; neutrophil; brain; head and neck neoplasms; medical record; transient ischemic attack; drug clearance; pleura effusion; seizure; leukocyte count; cancer control; metastases; infusions, intravenous; head and neck carcinoma; small intestine obstruction; meningeal metastasis; electrolyte disturbance; neoplasms, unknown primary; central nervous system metastasis; parenchyma; transaminitis; brain radiography; leptomeninges; brain hypoxia |
| Journal Title: | Journal of Neuro-Oncology |
| Volume: | 78 |
| Issue: | 3 |
| ISSN: | 0167-594X |
| Publisher: | Springer |
| Date Published: | 2006-07-01 |
| Start Page: | 255 |
| End Page: | 260 |
| Language: | English |
| DOI: | 10.1007/s11060-005-9044-6 |
| PUBMED: | 16344918 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 39" - "Export Date: 4 June 2012" - "CODEN: JNODD" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work