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Publications

Journal Article Review Ahead of print

PubMed: 42187128 DOI: 10.1080/14737140.2026.2677940

A nephrology perspective on the clinical impact and management of delayed high-dose methotrexate elimination.

Expert Rev Anticancer Ther

Authors: María José Soler, Laura Cosmai, Lui Forni, Jolanta Małyszko, Rukshana Shroff, Ben Sprangers, Corinne Isnard Bagnis

Affiliations

  • Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain.
  • Centro de Referencia en Enfermedad, Glomerular Compleja del Sistema Nacional de Salud de España (CSUR), Barcelona, Spain.
  • RICORS2040 (Kidney Disease), Barcelona, Spain.
  • Onco-Nephrology Outpatient Clinic, Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy.
  • Department of Critical Care, Royal Surrey Hospital Foundation Trust, Guildford, UK.
  • School of Medicine, University of Surrey, Guildford, UK.
  • Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
  • University College London Great Ormond Street Institute of Child Health, London, UK.
  • Department of Nephrology, Ziekenhuis Oost-Limburg, Genk, Belgium.
  • Department of Immunology and Infection, Biomedical Research Institute, UHasselt, Diepenbeek, Belgium.
  • Département de Néphrologie, APHP Sorbonne Université, Paris, France.
  • Groupe de Recherche Interdisciplinaire Francophone en Onco-Néphrologie (GRIFON), Paris, France.

Abstract

INTRODUCTION

Delayed methotrexate elimination (DME) is observed in ~15% of treatment cycles in patients with cancer receiving high-dose methotrexate (HDMTX). Given the strong association between DME and nephrotoxicity, oncologists might benefit from the input of a nephrologist/medical oncologist with a focus on nephrology when assessing and planning treatment for patients requiring HDMTX.

AREAS COVERED

Identifying patients who are at risk of DME and related acute kidney injury (AKI), and developing a bespoke assessment and monitoring plan (with a focus on kidney assessment and monitoring), may help to reduce the risk of complications and enable the continuation of HDMTX treatment, hopefully optimizing long-term survival outcomes.

EXPERT OPINION

In this perspective article, based on a search of PubMed literature and expert opinion, we explore the definition and causes of DME and AKI, and the impact of these on patients receiving HDMTX, and examine the key risk factors and early indicators of DME and AKI. A pathway with a nephrology focus is suggested for the assessment, monitoring, and treatment of patients with or at risk of DME.

MeSH

Leucovorin, Creatinine, Oncologists, Kidney, Nephrology, Therapeutics, Methotrexate