Glucarpidase Intervention for Delayed Methotrexate Clearance

Objective: To review and evaluate the current published literature on the effectiveness and safety of glucarpidase and to determine its potential role in clinical practice. Data Sources: A PubMed literature search from 1946 to January 2014 was performed using the search terms carboxypeptidase G2, glucarpidase, high-dose methotrexate, and leucovorin rescue. Additional references were identified by reviewing the references from the PubMed search articles. Study Selection and Data Extraction: English-language clinical trials and retrospective studies assessing the safety and effectiveness of glucarpidase were included. Case reports were excluded. Data Synthesis: A total of 5 non-randomized, prospective studies and 1 retrospective study evaluated the effectiveness and safety of glucarpidase in patients receiving high-dose methotrexate. In these studies, glucarpidase conferred a >87% reduction in serum methotrexate concentrations (sMTX) and was well tolerated. Although a substantial reduction in sMTX was obser...