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Outpatient High-dose Methotrexate for Osteosarcoma

It’s Safe and Feasible, If You Want It

Hendershot, Eleanor MN, BSCN*; Volpe, Jocelyn MN, BSCN; Taylor, Tracey BSc†,‡; Nicksy, Darcy BSc; Mills, Denise MN, BSCN; Ramachandran, Nivetha BSc; Shaikh, Furqan MD, MSc; Riss, Vera BSCN; Grant, Ronald MD; Gupta, Abha A. MSc, MD

Journal of Pediatric Hematology/Oncology: July 2019 - Volume 41 - Issue 5 - p 394–398
doi: 10.1097/MPH.0000000000001238
Clinical and Laboratory Observations

Background: High-dose methotrexate (HD MTX) is usually administered as an inpatient to those with osteosarcoma. We prospectively tested the safety and feasibility of administering HD MTX in the ambulatory setting.

Materials and Methods: In this single arm prospective observational study, eligible patients had previously completed 2 courses of HD MTX as an inpatient. On study, patients received MTX in hospital, discharged home and returned for daily assessment. Criteria to determine safety and feasibility included: (1) parent compliance with home instructions, (2) pump functioning/failure, and/or (3) admission for toxicity/noncompliance. Outpatient therapy was deemed feasible if <25% courses resulted in study event. Patient satisfaction was assessed.

Results: Six patients (median age, 13.5 y) with extremity osteosarcoma completed 35 courses of MTX. There were no study events—no hospitalizations or pump failures and all parents were compliant. The Data and Safety Committee concluded that with zero events in 35 courses, it was unlikely for outpatient MTX to be infeasible; study was thus terminated early. Participants reported value to stay out of hospital, permitted life to feel “more normal”; however, burden of daily commute to hospital was cited.

Conclusions: The delivery of HD MTX is safe and feasible in patients with osteosarcoma.

*Division of Hematology/Oncology, McMaster Children’s Hospital

Division of Hematology/Oncology, Hospital for Sick Children

Department of Pharmacy, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

Supported by the Garron Family Cancer Center, Hospital for Sick Children.

The authors declare no conflict of interest.

Reprints: Abha A. Gupta, MSc, MD, 555 University Ave., Toronto, Ontario, Canada M5G 1×8 (e-mail:

Received January 15, 2018

Accepted April 16, 2018

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