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.
Zoubek
A
A
St. Anna Children's Hospital, Vienna, Austria.
Zaunschirm
H A
HA
Lion
T
T
Fischmeister
G
G
Vollnhofer
G
G
Gadner
H
H
Pillwein
K
K
Schalhorn
A
A
Bode
U
U
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