Case Report: Serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidote

Frontiers in Oncology

Oncology

Aditya Sharma¹  David Nierenberg²  Philip Benoit³  Frederick Lansigan³ 

[1] Department of Medicine, Dartmouth Health, Lebanon, NH, United States;Department of Pharmacology, Dartmouth Health, Lebanon, NH, United States;Division of Hematology/Oncology, Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, United States;

关键词: methotrexate;    serum;    monitoring;    antidote;    glucarpidase;    leucovorin;    toxicity;   

DOI  :  10.3389/fonc.2023.1237178

 received in 2023-06-14, accepted in 2023-09-28,  发布年份 2023

来源: Frontiers

【 摘 要 】

Methotrexate is a commonly used agent in the treatment of many malignancies and rheumatologic/inflammatory diseases. Working by inhibiting dihydrofolate reductase and thereby preventing eventual formation of tetrahydrofolate, methotrexate inhibits synthesis of purines and thymidylate, therefore disabling a malignant cell’s ability to replicate. While it is able to effectively do this, methotrexate also holds potential for significant toxicity. Therefore, serum methotrexate monitoring is of utmost importance when administering the drug, particularly when high doses are used. Although there are several different measurement systems, the immunoassay is a commonly used monitoring system that may be prone to interference when using agents with similar carbon backbone as methotrexate, including folinic acid (leucovorin) at high doses, as well as in the setting of glucarpidase use and consequent methotrexate breakdown. However, adjusting leucovorin dosing policy and being aware of the potential of the immunoassay to be “confused” by similar molecules have allowed for the efficient and effective use of the immunoassay while preventing prolonged hospital stays at our institution.

【 授权许可】

Unknown   
Copyright © 2023 Sharma, Benoit, Lansigan and Nierenberg