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The purpose of methotrexate saturation test in chemotherapy of gestational trophoblastic disease



The purpose of methotrexate saturation test in chemotherapy of gestational trophoblastic disease



Journal of Catholic Medical College 44(1): 213-222



The clinical pharmacology of methotrexate, administered in conventional intravenous doses, has been studied extensively in man utilizing a variety of assay techniques. However, only a few studies have been undertaken to investigate the pharmacology of intermediate doses of methotrexate followed by delayed rescue with citrovorum factor. So, we have reached the following conclusion, which is drawn by methotrexate saturation test. With that, we may eliminate drug resistance which can be the main problem in methotrexate chemotherapy and we can figure out the proper timing or dosage of leucovorin rescue for more efficient anticancer chemotherapy. 1. Methotrexate serum level reaches up to the highest point in 30 minutes after the intravenous infusion, and 3.64 .+-. 1.99 hour is its half life. 2. In case leucovorin rescue is used, we give it folic acid 30 mg, without regarding methotrexate serum level, at 24 and 48 hours after methotrexate intravenous infusion. The average methotrexate serum level is 0.50 .mu. mole/liter when we give folic acid at 24 hours after methotrexate intravenous infusion. And the average methotrexate serum level is 0.32 .mu. mole/liter when we give folic acid at 48 hours after methotrexate intravenous infusion. 3. During the methotrexate chemotherapy, the relation with drug toxicity and half life remains longer than average, the drug toxicity is a lot stronger. But there seems no strict statistical significance. In case of hepatotoxicity, there is no special difference between the drug toxicity of methotrexate chemotherapy and the serum level after 48 hours of methotrexate intravenous infusion. But in case of hematologic toxicity, the group of higher methotrexate serum level appear a stronger toxicity than the lower methotrexate serum level group. Therefore, authors made the conclusion that methotrexate saturation test should be done to identify patients who would react to the drug toxicity in case of anticancer chemotherapy of methotrexate, and to administrate the proper leucovorin rescue for preventing drug toxicity.

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