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Guidelines
Resources
MTX Monitoring Tool
Expert Discussions
Clinical Articles

Guidelines

Consensus Guidelines

Consensus Guideline for Use of Glucarpidase in Patients with High‐Dose Methotrexate Induced Acute Kidney Injury and Delayed Methotrexate Clearance.

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Highlights - Consensus Guidelines

Highlighted excerpts from the Consensus Guideline for Use of Glucarpidase in Patients with High-Dose Methotrexate Induced Acute Kidney Injury and Delayed Methotrexate Clearance.

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Glucarpidase Treatment Algorithm

Download and print for your practice: Treatment algorithm based on the Consensus Guidelines.

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Stocking Guidelines

Review the stocking guidelines established by an international expert panel.
 

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NCCN Guidelines

Review the National Comprehensive Cancer Network Guidelines for treating various cancers.

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Resources

Early Warning Signs

Download this resource to help you identify the early warning signs for methotrexate toxicity.

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Methotrexate Monitoring Tool

Methotrexate Monitoring Tool

Visit MTXPK.org to see if your patient is clearing MTX as expected. This tool was independently developed by Dr. Laura Ramsey of Cincinnati Children’s Medical Center and lead author of the Consensus Guidelines5 and provides:
 

  • A free, open-access clinical decision-making tool for monitoring plasma MTX elimination in both adult and pediatric patients
  • No log in required
  • No patient data stored on the website (but can be stored to local computer and browser)
  • Visual display of data shows expected and actual MTX elimination curves along with serum creatinine trend and predicted time to reach discharge threshold levels
  • Patient report can be downloaded and saved as PDFs or printed

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Expert Discussions

The ASCO® Post CME

Review a roundtable discussion between 3 experts about how to identify patients treated with HDMTX who are at risk for developing AKI, the clinical implications of guidelines, and strategies to integrate guidelines into practice.

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Consensus Guideline Expert Interview

Watch and listen to experts discuss important information about guidelines for managing patients with delayed methotrexate elimination due to renal impairment.

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JADPRO CE

Review the management of delayed MTX elimination due to AKI according to published clinical guidelines using two certified case-based activities of HDMTX toxicity created for oncology advanced practitioners.
 

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Clinical Articles

Length of stay, mortality, and readmissions among Medicare cancer patients treated with glucarpidase and conventional care: a retrospective study.

Examine hospital length of stay, mortality, and readmission rates for Medicare cancer patients with delayed clearance of MTX treated with glucarpidase.

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References

  1. Voraxaze® [prescribing information]. BTG International Inc; 2013.
  2. Howard SC, et al. Preventing and managing toxicities of high-dose methotrexate. The Oncologist 2016; 21:1-12.
  3. Widemann BC, Balis FM, Kim A, et al. Glucarpidase, leucovorin, and thymidine for high-dose methotrexate-induced renal dysfunction: clinical and pharmacologic factors affecting outcome. J Clin Oncol. 2010; 28:3979-3986.
  4. 2013 Annual Meeting of the North American Congress of Clinical Toxicology (NACCT), Clinical Toxicology 2013; 51(7):575-724. doi:10.3109/15563650.2013.817658.
  5. Ramsey L, Balis FM, O’Brien MM, et al. Consensus guidelines for use of glucarpidase in patients with high-dose methotrexate induced acute kidney injury and delayed methotrexate clearance. Durham, NC. The Oncologist. 2017 Oct 27. doi: 10.1634/theoncologist.2017-0243
  6. Widemann BC, Adamson PC. Understanding and managing methotrexate nephrotoxicity. Oncologist. 2006;11:694-703
  7. Schwartz S, Borner K,Müller K, et al. Glucarpidase (carboxypeptidase G2) intervention in adult and elderly cancer patients with renal dysfunction and delayed methotrexate elimination after high-dose methotrexate therapy. Oncologist. 2007;12:1299-1308.
  8. Widemann BC, Balis FM, Kempf-Bielack B, et al. High-dose methotrexate-induced nephrotoxicity in patients with osteosarcoma. Cancer. 2004;100:2222-2232
  9. Data on file. BTG International Inc. 2012.
  10. de Miguel D, García-Suárez J Martín Y, Gil-Fernández JJ, Burgaleta C. Severe acute renal failure following high-dose methotrexate therapy in adults with haematological malignancies: a significant number result from unrecognized co-administration of several drugs. Nephrol Dial Transplant. 2008;23:3762-3766.
  11. Jahnke K, Korfel A, Martus P, et al; on behalf of the German Primary Central Nervous System Lymphoma Study Group (G-PCNSL-SG). High-dose methotrexate toxicity in elderly patients with primary central nervous system lymphoma. Ann Oncol. 2005;16:445-449
  12. Flombaum C, Meyers P. High-dose leucovorin as sole therapy for methotrexate toxicity. Journal of Clinical Oncology 1999; 17(5): 1589-1594.
  13. Murashima M, et al. Methotrexate clearance by high-flux hemodialysis and peritoneal dialysis: a case report. Am J Kidney Dis 2009; 53:781-874.
  14. Wall S, Johansen M, et al. Effective clearance of methotrexate using high-flux hemodialysis membranes. Am J Kidney Dis 1996; 28(6):846-854.
  15. Dart RC, Goldfrank LR, Erstad BL, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2018;71(3):314-325.
  16. Green JM. Glucarpidase to combat toxic levels of methotrexate in patients. Ther Clin Risk Manag. 2012;8:403-4
  17. Glucarpidase (Voraxaze®) National Drug Monograph and Considerations for Use. U.S. Department of Veterans Affairs website. 2014. http://www.pbm.va.gov/clinicalguidance/drugmonographs/Glucarpidase_ Drug_Monograph_and_Considerations_for_Use.doc. Published June 2014. Accessed November 04, 2016.
  18. Leucovorin [prescribing information]. Bedford Laboratories; 2011.