Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, People's Republic of China.
J Clin Pharm Ther. 2022 Sep;47(9):1452-1460. doi: 10.1111/jcpt.13739. Epub 2022 Aug 5.
High-dose methotrexate (HDMTX) is active against various malignancies; it possesses serious toxicities and is associated with patient characteristics, dosage regimens, comedications, and physiological status. There are many strategies to overcome HDMTX-induced toxicities, such as hydration, alkalization, leucovorin rescue, and haemodialysis. Leucovorin rescue is a cornerstone for toxicity prevention in HDMTX treatment. However, the leucovorin dose adjustment and the existence of leucovorin overrescue are still controversial. At present, various methods for calculating leucovorin doses in different tumour types have been proposed, including empirical calculations based on MTX plasma concentration, the Bleyer nomogram, and other methods. Nonetheless, leucovorin rescue protocols differ greatly across tumour types and medical institutions. Further studies are needed to investigate the optimal dosage regimen for leucovorin rescue in various tumours using HDMTX.
大剂量甲氨蝶呤（HDMTX）对各种恶性肿瘤均有活性；它具有严重的毒性，并与患者特征、剂量方案、合并用药和生理状态有关。有许多策略可以克服 HDMTX 诱导的毒性，如水化、碱化、亚叶酸钙解救和血液透析。亚叶酸钙解救是 HDMTX 治疗中预防毒性的基石。然而，亚叶酸钙剂量的调整和亚叶酸钙过度解救仍然存在争议。目前，已经提出了用于计算不同肿瘤类型中亚叶酸钙剂量的各种方法，包括基于 MTX 血浆浓度的经验计算、Bleyer 列线图和其他方法。然而，肿瘤类型和医疗机构之间的亚叶酸钙解救方案差异很大。需要进一步研究使用 HDMTX 治疗各种肿瘤时亚叶酸钙解救的最佳剂量方案。
