High-dose methotrexate as secondary chemotherapy in metastatic soft-tissue sarcomas.

High-dose methotrexate in a dose of 2-4 g/m2 every four weeks was given as secondary chemotherapy to 22 patients with metastatic soft-tissue sarcoma; toxic reactions included 1 death and 2 instances of moderate hematopoietic toxicity. The remaining patients tolerated this treatment without difficulty. Of 18 patients with measurable evaluable disease, 17 demonstrated progression. One patient with metastatic angiosarcoma had a complete response lasting for 15 months. Three patients were given adjuvant high-dose methotrexate following wedge resections of pulmonary metastases. One patient demonstrated recurrence after four months, another after 13 months, and the third after 15 months. One additional patient underwent resection of pulmonary metastases following two months of stabilization with high-dose methotrexate and has continued free of disease with high-dose methotrexate as adjuvant for eight months. Five patients are alive and have been disease-free for an average period of 14 months. Four of these underwent operative treatment combined with chemotherapy. The effectiveness of high-dose methotrexate appears limited in soft-tissue sarcomas when it is given as secondary chemotherapy.