Successful carboxypeptidase G2 rescue in delayed methotrexate elimination due to renal failure.
We report on an 18.5-year-old woman with osteosarcoma and delayed methotrexate (MTX) elimination due to renal failure after high-dose MTX, in whom rescue with high doses of folinic acid caused intolerable side effects. In this life-threatening clinical situation, the patients was rescued by the administration of recombinant carboxypeptidase G2, a bacterial enzyme that rapidly hydrolyzes MTX into inactive metabolites. This is the first report on the successful clinical use of this alternative catabolic route for the elimination of MTX.
St. Anna Children's Hospital, Vienna, Austria.
A
A
Zoubek
H A
HA
Zaunschirm
T
T
Lion
G
G
Fischmeister
G
G
Vollnhofer
H
H
Gadner
K
K
Pillwein
A
A
Schalhorn
U
U
Bode
D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000493:pharmacokinetics*; D012516:Osteosarcoma / Q000188:drug therapy; D011994:Recombinant Proteins / Q000494:pharmacology; D051437:Renal Insufficiency / Q000378:metabolism*; D011623:gamma-Glutamyl Hydrolase / Q000494:pharmacology*
D000964:Antimetabolites, Antineoplastic; D011994:Recombinant Proteins; D011623:gamma-Glutamyl Hydrolase; D008727:Methotrexate