Journal of Clinical Oncology, Vol 1, 428-431, Copyright © 1983 by American Society of Clinical Oncology
Treatment of primary osteosarcoma with intra-arterial and intravenous high-dose methotrexate
N Jaffe, J Prudich, J Knapp, YM Wang, R Bowman, A Cangir, A Ayala, V Chuang and S Wallace
In an effort to achieve high concentrations and prolonged exposure times,
high-dose methotrexate (MTX) was administered by the intra- arterial route
over 6 hours at a dose of 12.5 g/m2 to nine patients with osteosarcoma.
This was followed by citrovorum factor (CF) rescue, which was initiated 12
hours after completion of the infusion (MTX-CF). The regimen achieved high
local concentrations over a finite period. No toxicity was encountered.
Treatment was administered at weekly intervals, during which intravenous
MTX-CF was interposed if facilities for intra-arterial administration were
not available. However, despite increases in local venous concentrations
and exposure times, only four of nine patients (44%) responded. This is
similar to responses achieved with 7.5 g/m2 (48%) with CF initiated 2 hours
after completion of the infusion. Higher MTX doses, intra-arterial
administration, and prolongation of cytotoxic exposure time did not confer
a therapeutic advantage as opposed to "conventional" intravenous high
doses.
