Sequential methotrexate and 5-fluorouracil in the treatment of non-small cell carcinoma of the lung
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The experience is reported of the use of the totally implantable "Infusaid" infusion pump in the treatment of 14 patients in our combined clinics for metastatic carcinoma in the liver by means of the antimetabolite 5-FU. At the time of this study the more active antimetabolite 5-FUDR was not available. A comparison is made of overseas reports of the use of 5-FUDR in the Infusaid infusion pump with the experience, in our clinic, of the use of 5-FU.
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An enzymatic method for the measurement of methotrexate (MTX) in serum is presented in which the inhibition of the enzyme dihydrofolate reductase by MTX is measured. Reduction of the substrate dihydrofolate by the enzyme and cofactor NADPH is lessened in direct proportion to the amount of MTX present. Measurements can be made in the "therapeutic range" of MTX which corresponds to the 10(-7) to 10(-8) M concentration of MTX in serum.
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Methotrexate is an important drug in the armamentarium available to physicians to treat patients with moderate to severe psoriasis. The drug has a 40-year track record and has proven to be effective in cases in psoriasis that are refractory to other intense forms of treatment. While it has proven efficacy, methotrexate also has the potential for both acute and chronic toxicity. Patients must be carefully selected and the drug administered according to specific guidelines to guard against the development of serious side effects. Methotrexate is best used by individuals very familiar with psoriasis and equally well-versed in the complexities of managing patients on antimetabolite therapy.
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The antitumor effects of methotrexate with 5-fluorouracil against the Sarcoma 180 mouse tumor model were found to be schedule dependent. Pretreatment of tumor-bearing animals with methotrexate significantly enhanced the antitumor activity of the combination relative to simultaneous treatment or to those with methotrexate following 5-fluorouracil. These studies indirectly support the hypothesis that methotrexate pretreatment with 5-fluorouracil is synergistic by increasing the amount of thymidylate synthetase bound to the active metabolite of 5-fluorouracil.
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Five patients with oligoarticular rheumatoid arthritis were treated with intra-articular injections of methotrexate and orgotein in the knee joints. The employed dose of the antimetabolite was very low and orgotein was simultaneously administered to prevent local tissues from cytolysis-related damage. Clinical results were fairly good and support the hypothesis that methotrexate may be used intra-articularly as an immunosuppressor rather than at the heavily toxic doses required for a cytostatic effect.
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The experience is reported of the use of the totally implantable "Infusaid" infusion pump in the treatment of 14 patients in our combined clinics for metastatic carcinoma in the liver by means of the antimetabolite 5-FU. At the time of this study the more active antimetabolite 5-FUDR was not available. A comparison is made of overseas reports of the use of 5-FUDR in the Infusaid infusion pump with the experience, in our clinic, of the use of 5-FU.
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The antimetabolite 5-fluorouracil is frequently used in the therapy of various malignancies. Cardiotoxicity has frequently been described during treatment, but there is no common agreement on the need to perform cardiovascular monitoring of patients during 5-fluorouracil administration. We report the case of a young patient with an head-neck cancer on whom a continuous electrocardiogram recording was performed, documenting serious ventricular dysrhythmias in the presence of myocardial ischemia during 5-fluorouracil and cis-platin infusion.
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The antimetabolite methotrexate has been shown in placebo-controlled trials to be effective in adults with rheumatoid arthritis. Methotrexate may also be effective in children with resistant juvenile rheumatoid arthritis, but the supporting data are from uncontrolled trials.
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Methotrexate is an antimetabolite used as a treatment for a variety of neoplastic and inflammatory diseases. It has a variety of cutaneous side effects, in particular when administered in high doses. This is a report of cutaneous eruptions in three patients treated with methotrexate and a review of eruptions linked to methotrexate.
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