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oai:recercat.cat:11351/122702025-10-24T10:38:14Zcom_2072_378070com_2072_378040col_2072_378092

2025-10-24T10:38:14Z urn:hdl:11351/12270 A European consensus recommendation on the management of delayed methotrexate elimination: supportive measures, leucovorin rescue and glucarpidase treatment Bielack, Stefan soussain, carole Fox, Christopher Paul Houillier, Caroline Murciano, Thais Osborne, Wendy Càncer - Tractament Decisió de grup Antimetabòlits - Ús terapèutic DISEASES::Neoplasms Other subheadings::Other subheadings::Other subheadings::/drug therapy CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Antimetabolites::Antimetabolites, Antineoplastic Other subheadings::Other subheadings::/therapeutic use PSYCHIATRY AND PSYCHOLOGY::Behavior and Behavior Mechanisms::Psychology, Social::Group Processes::Consensus ENFERMEDADES::neoplasias Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::mecanismos moleculares de acción farmacológica::antimetabolitos::antimetabolitos antineoplásicos Otros calificadores::Otros calificadores::/uso terapéutico PSIQUIATRÍA Y PSICOLOGÍA::conducta y mecanismos de la conducta::psicología social::procesos de grupo::consenso Consensus; Glucarpidase; Methotrexate toxicity Consens; Glucarpidasa; Toxicitat del metotrexat Consenso; Glucarpidasa; Toxicidad del metotrexato High-dose methotrexate (HDMTX) is used in the treatment of a range of adult and childhood cancers. Although HDMTX can provide effective anti-tumor activity with an acceptable safety profile for most patients, delayed methotrexate elimination (DME) develops in a minority of patients receiving HDMTX and may be accompanied by renal dysfunction and potentially life-threatening toxicity. A panel of European physicians with experience in the use of HDMTX as well as of glucarpidase convened to develop a series of consensus statements to provide practical guidance on the prevention and treatment of DME, including the use of glucarpidase. Robust implementation of supportive measures including hyperhydration and urine alkalinization emerged as critical in order to reduce the risk of DME with HDMTX treatment, with leucovorin rescue critical in reducing the risk of DME complications. Early recognition of DME is important to promptly implement appropriate treatment including, intensified hydration, high-dose leucovorin and, when appropriate, glucarpidase. 2025-10-24T10:38:14Z 2025-10-24T10:38:14Z 2024-11-25T13:38:42Z 2024-11-25T13:38:42Z 2024-10-02 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://hdl.handle.net/11351/12270 Journal of Cancer Research and Clinical Oncology;150(10) https://doi.org/10.1007/s00432-024-05945-6 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess Springer Scientia