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Commentary: a case for minimizing folate supplementation in clinical regimens with pemetrexed based on the marked sensitivity of the drug to folate availability.
Chattopadhyay, Shrikanta; Tamari, Roni; Min, Sang H; Zhao, Rongbao; Tsai, Eugenia; Goldman, I David.
Afiliação
  • Chattopadhyay S; Department of Medicine, The Albert Einstein College of Medicine Cancer Center, Bronx, NY 10461, USA.
Oncologist ; 12(7): 808-15, 2007 Jul.
Article em En | MEDLINE | ID: mdl-17673612
Pemetrexed is a novel antifolate recently approved for the treatment of pleural mesothelioma and non-small cell lung cancer. In clinical regimens, pemetrexed is administered in conjunction with folic acid to minimize toxicity. However, excessive folate supplementation may also diminish the activity of this agent. The current study demonstrates, in several human solid tumor cell lines, that when extracellular 5-formyltetrahydrofolate levels are increased in vitro, within the range of normal human blood levels, there is a substantial decrease in pemetrexed activity upon continuous exposure to the drug. This was accompanied by a comparable lower level of trimetrexate activity consistent with an expansion of tumor cell folate pools. Likewise, when cells were exposed to pemetrexed with a schedule that simulates in vivo pharmacokinetics, there was markedly less cell killing with higher extracellular folate levels. Data are provided to indicate that 5-formyltetrahydrofolate is an acceptable surrogate for 5-methyltetrahydrofolate, the major blood folate, for this type of in vitro study. These observations and other reports suggest that, in view of the rise in serum folate and fall in serum homocysteine that has accompanied folic acid supplementation of food in the U.S., the addition of folic acid to regimens with pemetrexed should be limited to the lowest recommended level that provides optimal protection from pemetrexed toxicity.
Assuntos
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tetra-Hidrofolatos / Ácido Fólico / Antagonistas do Ácido Fólico / Glutamatos / Guanina / Antimetabólitos Antineoplásicos Tipo de estudo: Diagnostic_studies Limite: Humans Idioma: En Revista: Oncologist Assunto da revista: NEOPLASIAS Ano de publicação: 2007 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Reino Unido
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tetra-Hidrofolatos / Ácido Fólico / Antagonistas do Ácido Fólico / Glutamatos / Guanina / Antimetabólitos Antineoplásicos Tipo de estudo: Diagnostic_studies Limite: Humans Idioma: En Revista: Oncologist Assunto da revista: NEOPLASIAS Ano de publicação: 2007 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Reino Unido