[Carboxypeptidase-G2 administration after high-dose methotrexate. Treatment and drug interactions].

  title={[Carboxypeptidase-G2 administration after high-dose methotrexate. Treatment and drug interactions].},
  author={J A C{\'o}zar Olmo and C Mart{\'i}nez Colmenero and I Pel{\'a}ez Pleguezuelos and Isabel Leiva Gea and Ana Bel{\'e}n L{\'o}pez Garc{\'i}a and Jes{\'u}s de la Cruz Moreno},
  journal={Anales de pediatria},
  volume={71 3},
Methotrexate (MTX) is widely used as anticancer agent in various malignancies, including acute lymphoblastic leukaemia, lymphoma and osteosarcoma. High doses of MTX may cause acute renal dysfunction. Nephrotoxicity is prevented by the use of alkalinization and hydration. More recently Carboxypeptidase-G2, a recombinant bacterial enzyme that rapidly hydrolyzes MTX to inactive metabolites, has become available for the treatment of acute nephrotoxicity. On the other hand, glutamine is usually… Expand
1 Citations
Glucarpidase (voraxaze), a carboxypeptidase enzyme for methotrexate toxicity.
Glucarpidase (Voraxaze) for methotrexate toxicity and its application in clinical practice is still under investigation. Expand


Understanding and managing methotrexate nephrotoxicity.
CPDG(2) administration has been well tolerated and resulted in consistent and rapid reductions in plasma MTX concentrations by a median of 98.7% (range, 84%-99.5%). Expand
Carboxypeptidase G2 rescue in patients with methotrexate intoxication and renal failure
Administration of CPDG2 is a well-tolerated, safe and a very effective way of MTX elimination in delayed excretion due to renal failure in patients with MTX-induced renal failure and delayed MTX excretion. Expand
Carboxypeptidase-G2, thymidine, and leucovorin rescue in cancer patients with methotrexate-induced renal dysfunction.
  • B. Widemann, F. Balis, +4 authors P. Adamson
  • Medicine
  • Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 1997
CPDG2, thymidine, and leucovorin rescue was highly effective in 20 patients at high risk for developing life-threatening methotrexate toxicity after the onset of methotRexate-induced nephrotoxicity and delayed methot Rexate excretion. Expand
Optimal Management of Methotrexate Intoxication in a Child with Osteosarcoma
The time course and management of methotrexate (MTX) toxicity in a 14-year-old Hispanic boy with osteosarcoma treated with high-dose MTX is described, suggesting that MTX may be a cause of these complications. Expand
Carboxypeptidase‐G2 rescue in a patient with high dose methotrexate‐induced nephrotoxicity
Bacterial enzyme carboxypeptidase‐G2 (CPDG2) hydrolyzes MTX into inactive metabolites and has been demonstrated to lower plasma MTX concentrations to nontoxic levels rapidly in the nonhuman primate after HDMTX infusion. Expand
Severe acute toxicity associated with high-dose methotrexate (MTX) therapy: use of therapeutic drug monitoring and test-dose to guide carboxypeptidase G2 rescue and MTX continuation
A patient affected by an osteosarcoma, underwent life-threatening toxicities following the first course of HD-MTX and received two doses of CPDG2 as a specific rescue, and therapeutic drug monitoring was performed using an high-performance liquid chromatography method, since fluorescence polarization immunoassay became unreliable. Expand
Pharmacokinetics and metabolism of the methotrexate metabolite 2, 4-diamino-N(10)-methylpteroic acid.
Metabolism underlies the more rapid elimination of DAMPA versus MTX in patients with MTX-induced renal dysfunction after administration of CPDG(2), suggesting nonrenal elimination. Expand
Influence of high-dose methotrexate therapy (HD-MTX) on glomerular and tubular kidney function.
The administration of HD-MTX has no direct tubulotoxic effect and the disturbance in glomerular function was dose dependently and indicated by an increase in proteinuria as well as by a decrease in GFR; all changes were completely reversible and did not correlate to the metabolism of MTX to 7-OH- MTX. Expand
Effect of glutamine on methotrexate efficacy and toxicity.
These studies suggest that GLN supplementation is safe in its administration to the tumor-bearing host receiving MTX, and may serve to increase the therapeutic window of this chemotherapeutic age. Expand
High‐dose methotrexate‐induced nephrotoxicity in patients with osteosarcoma
The objectives of the current study were to estimate the current incidence of HDMTX‐induced renal dysfunction in patients with osteosarcoma and to compare the efficacy and recovery of renal function for dialysis‐based methods of MTX removal with treatment using CPDG2. Expand