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Cancer Chemotherapy and Pharmacology
Published in: Cancer Chemotherapy and Pharmacology 4/2017

01-04-2017 | Letter to the Editor

Reply: Methotrexate neurotoxicity due to drug interactions: an inadequate folinic acid effect

Authors: Victoria J. Forster, Frederik W. van Delft, Susan F. Baird, Shona Mair, Roderick Skinner, Christina Halsey

Published in: Cancer Chemotherapy and Pharmacology | Issue 4/2017

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Excerpt

We thank Professor Cohen for his reply and his interesting points regarding the possible role of inadequate folinic acid rescue in contributing to neurotoxic side-effects of methotrexate. We can confirm that the patient reported in our article [1] had not received any previous exposure to any systemic methotrexate (oral or intravenous) even at low dose. In addition, the other published article on this possible interaction with nitrous oxide [2] reported a patient developing symptoms early during induction therapy on a protocol with a standard 3-drug induction (vincristine, asparaginase and corticosteroids). Therefore, concomitant systemic methotrexate appears not to be a contributing factor in either of these reported cases. …
Literature
1.
Forster VJ, van Delft FW, Baird SF, Mair S, Skinner R, Halsey C (2016) Drug interactions may be important risk factors for methotrexate neurotoxicity, particularly in pediatric leukemia patients. Cancer Chemother Pharmacol 78(5):1093–1096CrossRefPubMedPubMedCentral
2.
Lobel U, Trah J, Escherich G (2015) Severe neurotoxicity following intrathecal methotrexate with nitrous oxide sedation in a child with acute lymphoblastic leukemia. Pediatr Blood Cancer 62(3):539–541CrossRefPubMed
3.
Krull KR, Cheung YT, Liu W et al (2016) Chemotherapy pharmacodynamics and neuroimaging and neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia. J Clin Oncol 34(22):2644–2653CrossRefPubMedPubMedCentral
4.
Cohen IJ (2014) Inadequate folinic acid rescue after methotrexate causing neurocognitive and neuroradiological central nervous system late effects in children with acute lymphatic leukemia. J Pediatr Hematol Oncol 36(6):501CrossRefPubMed
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Cohen IJ (2013) Challenging the clinical relevance of folinic acid over rescue after high dose methotrexate (HDMTX). Med Hypotheses 81(5):942–947CrossRefPubMed
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Skarby TV, Anderson H, Heldrup J et al (2006) High leucovorin doses during high-dose methotrexate treatment may reduce the cure rate in childhood acute lymphoblastic leukemia. Leukemia 20(11):1955–1962CrossRefPubMed
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Borsi JD, Sagen E, Romslo I, Moe PJ (1990) Rescue after intermediate and high-dose methotrexate: background, rationale, and current practice. Pediatr Hematol Oncol 7(4):347–363CrossRefPubMed
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Eger EI 2nd (1985) Nitrous oxide/N2O. Elsevier, New York
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Cole PD, Beckwith KA, Vijayanathan V, Roychowdhury S, Smith AK, Kamen BA (2009) Folate homeostasis in cerebrospinal fluid during therapy for acute lymphoblastic leukemia. Pediatr Neurol 40(1):34–41CrossRefPubMed
Metadata
Title
Reply: Methotrexate neurotoxicity due to drug interactions: an inadequate folinic acid effect
Authors
Victoria J. Forster
Frederik W. van Delft
Susan F. Baird
Shona Mair
Roderick Skinner
Christina Halsey
Publication date
01-04-2017
Publisher
Springer Berlin Heidelberg
Published in
Cancer Chemotherapy and Pharmacology / Issue 4/2017
Print ISSN: 0344-5704
Electronic ISSN: 1432-0843
DOI
https://doi.org/10.1007/s00280-017-3270-4

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