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A fatal outcome in a patient with glioblastoma multiforme after receiving high-dose methotrexate.


Posted on: 03/18/2008

J Oncol Pharm Pract. 2008 Mar;14(1):57-60.


A fatal outcome in a patient with glioblastoma multiforme after receiving high-dose methotrexate.

Price S, Harless W, Rikhye S, Altaha R.

Hematology/Oncology Pharmacist, West Virginia University Hospitals One Medical Center Drive Morgantown, WV 26506, USA. prices@wvuh.com.

The most common adult primary brain tumor is glioblastoma multiforme (GBM). Current treatment is surgical resection, adjuvant radiation and chemotherapy, which can extend the median survival 20-36 weeks (Mansky et al. Central nervous system tumors. In Abraham J, Allegra CJ, Gulley J, eds. Bethesda Handbook of clinical oncology, 2nd edn. Philadelphia, Pennsylvania: Lippincott Williams and Wilkins, 2000: 440-2; Knox S. Intracranial tumors. In Pillot G, Chantler M, Magiera H, Peles S, et al., eds. The Washington Manual Hematology and Oncology Subspecialty Consult. Philadelphia, Pennsylvania: Lippincott Williams and Wilkins, 2004: 204-6.). But treatment efficacy is limited, mandating the exploration of more effective treatments. We report on a patient with GBM treated as per a clinical protocol with high-dose methotrexate (12 g/m(2)), who expired within hours after the initiation of treatment secondary to transtentorial herniation. Although it is not completely clear what caused the patient's herniation, we think that high-dose methotrexate therapy may have played a crucial role. We suggest that high-dose methotrexate should be used cautiously in patients with GBM.

PMID: 18337442 [PubMed - in process]

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