High-dose methotrexate with citrovorum factor rescue and adriamycin in childhood osteogenic sarcoma

Abstract

Thirteen children with metastatic osteogenic sarcoma were given high-dose methotrexate (HDMTX) with Citrovorum factor (CF) rescue and adriamycin cyclic chemotherapy. HDMTX (100–750 mg/kg) IV. was infused during 4 hours, followed by CF administration (9 mg P.O. q6h × 12). Two weeks later, adriamycin, 2.5 mg/kg divided into three daily doses (1 mg/kg, 1 mg/kg, and 0.5 mg/kg), was given by I.V. injection. The cycle was repeated every 4 weeks. Of 13 patients treated, 7 had tumor regression for greater than 1 month. In 7/7 patients, the elevated serum alkaline phosphatase levels normalized after treatment, and 5/6 patients had relief of bone pain. HDMTX toxicity included mucositis, leukopenia, thrombocytopenia, transient elevation of SGOT, nausea and vomiting, and radiation pneumonitis in 2 patients who received thoracic irradiation after HDMTX. Responses and symptom-free survival in patients with advanced osteogenic sarcoma suggest that this treatment would be of value as adjuvant therapy in the treatment of primary osteogenic sarcoma in an effort to improve the poor cure rate with surgery alone.