Successful Carboxypeptidase G₂ Rescue in Delayed Methotrexate Elimination Due to Renal Failure

Andreas Zoubek St. Anna Children's Hospital, Vienna, Austria

Harald A. Zaunschirm St. Anna Children's Hospital, Vienna, Austria

Thomas Lion St. Anna Children's Hospital, Vienna, Austria

Gustav Fischmeister St. Anna Children's Hospital, Vienna, Austria

Georg Vollnhofer St. Anna Children's Hospital, Vienna, Austria

Helmut Gadner St. Anna Children's Hospital, Vienna, Austria

Konrad Pillwein Department of Pediatrics, University of Vienna, Austria

Andreas Schalhorn Medical Clinics III, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Germany

Udo Bode Department of Pediatrics, University of Bonn, Germany

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Abstract

We report on an 18.5-year-old woman with osteosarcoma and delayed methotrexate (MTX) elimination due to renal failure after high-dose MTX, in whom rescue with high doses of folinic acid caused intolerable side effects. In this life-threatening clinical situation, the patient was rescued by the administration of recombinant carboxypeptidase G₂, a bacterial enzyme that rapidly hydrolyzes MTX into inactive metabolites. This is the first report on the successful clinical use of this alternative catabolic route for the elimination of MTX.

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Successful Carboxypeptidase G₂ Rescue in Delayed Methotrexate Elimination Due to Renal Failure

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Successful Carboxypeptidase G₂ Rescue in Delayed Methotrexate Elimination Due to Renal Failure