High-dose methotrexate for patients with osteosarcoma in resource-poor settings

BACKGROUND: Methotrexate (MTX) is one of the most widely used antifolate analogs. It is active against both hematological and solid tumors. Healthcare providers are reluctant to use high-dose MTX (HDMTX) on patients in various institutions, especially in resource-poor settings. Not much data are available in the literature on the administration of HDMTX without monitoring serum MTX levels. The objective of this retrospective study was to gauge whether HDMTX can be administered safely without frequently measuring serum MTX levels. MATERIALS AND METHODS: This retrospective observational study was carried out at a tertiary cancer care centre in North India. In this retrospective observational study, the effect of 33 HDMTX cycles on five histologically proven patients with osteosarcoma from August 2018 to August 2020 was studied. The effect of HDMTX on various parameters, such as serum creatinine and haematological toxicities, was studied. The data were analyzed using IBM SPSS software version 26, Chicago, Illinois, U.S.A. RESULTS: Serum MTX levels were assessed at 48 h in all cycles, with a mean level of 0.39 ± 0.309 µmol/L. Creatinine increase was noticed in 19 (57.57%). Grade 3 neutropenia and Grade 4 thrombocytopenia developed in one (3%) cycle each. Hepatotoxicity in Grade 3 was observed in only one cycle (3.0%). CONCLUSIONS: HDMTX up to 8 g/m 2 may be safely administered even in LMIC with regular monitoring of urine output, urinary alkalinization, and serum creatinine monitoring.