Nové poznatky ve farmakologii methotrexátu – diagnostické možnosti a klinický význam

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Title in English New Findings in Methotrexate Pharmacology – Diagnostic Possibilities and Impact on Clinical Care
Authors

ŘIHÁČEK Michal PILÁTOVÁ Kateřina ŠTĚRBA Jaroslav PILNÝ Radomír VALÍK Dalibor

Year of publication 2015
Type Article in Periodical
Magazine / Source Klinická onkologie
MU Faculty or unit

Faculty of Medicine

Citation
Web http://www.linkos.cz/casopis-klinicka-onkologie/hledani-clanku/skupina/a/zobrazit/ids/4685/
Doi http://dx.doi.org/10.14735/amko2015163
Field Oncology and hematology
Keywords methotrexate; 7-hydroxymethotrexate; toxicity; pharmacokinetics; drug monitoring; polyglutamates
Description Methotrexate is an anti-cancer drug used to treat several malignancies including pediatric acute lymphoblastic leukemia and choriocarcinoma. Despite recent advances in cancer chemotherapy, it remains a mainstay of therapy since its discovery in the early second half of the previous century. Moreover, low-dose methotrexate is a gold standard antirheumatic drug in the treatment of rheumatoid arthritis, psoriasis, systemic scleroderma and other autoimmune disorders. Side effects of methotrexate treatment are WELLknown and described; however, their occurrence may often be unpredictable due to lack of specific biomarkers of toxicity. Methotrexate plasma levels are routinely monitored by therapeutic drug monitoring, nevertheless, occurrence and concentrations of its metabolites are not measured. During methotrexate treatment 7- hydroxymethotrexate and 2,4- diamino- N10- mehylpteroic acid appear in plasma. The latter can further be hydroxylated and glucuronidated resulting in five possible extracellular methotrexate metabolites. In addition, methotrexate is intracellularly converted to its active polyglutamylated forms. Therapeutic efficacy is dependent on formation of methotrexate polyglutamates as it keeps intracellular pool of the drug and enhances its affinity towards various target enzymes. In this study, we describe pharmacokinetic and pharmacodynamic characteristics of methotrexate metabolites. We also review methotrexate blood brain barrier transport to cerebrospinal fluid regarding its use in the prevention of leukemic central nervous system involvement and management of methotrexate toxicity with the use of carboxypeptidase- G2. Finally, we discuss laboratory methods for monitoring methotrexate metabolites and benefits of simultaneous determination of methotrexate and metabolites as possible biomarkers of therapeutic efficacy and clinical toxicity.
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