Treatment of central nervous system tumors with methotrexate.
Thirteen patients with primary and metastatic CNS tumors have been treated with methotrexate (MTX) using three different approaches: (a) high-dose MTX with leucovorin (LV) rescue; (b) high-dose MTX with carboxypeptidase (CPDG) rescue; and (c) intraventricular administration of low doses of MTX for extended periods (concentration X time [CXT]). Eleven patients had central nervous system (CNS) lymphoma (one primary, one patient had recurrent medulloblastoma, and another patient had metastatic breast carcinoma. All 13 patients received high-dose MTX-LV rescue, while 3 patients were subsequently given MTX-CPDG. One patient received MTX by all three modalities. In patients with CNS lymphomas, complete responses (45%) and partial responses (36%) produced CNS disease-free intervals ranging from 1 to 23+ months. Survival for the complete responders has thus far ranged from 2.5 to 35 months, while the partial responders survived from 3 to 5 months. Two patients failed to respond and survived 2.5 and 3 months. Responses were obtainable with high-dose MTX-CPDG in patients resistant to MTX-LV. One patient who became sensitized to CPDG subsequently responded to MTX by intraventricular CXT administration. Thus, MTX can be effectively administered to patients with CNS tumors by several different approaches.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy; D002268:Carboxypeptidases / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007276:Injections, Intraventricular; D002955:Leucovorin / Q000008:administration & dosage; D008223:Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D013997:Time Factors
D002268:Carboxypeptidases; D002955:Leucovorin; D008727:Methotrexate