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Journal of Oncology Pharmacy Practice, Vol. 14, No. 1, 57-60 (2008)
DOI: 10.1177/1078155207081953

A fatal outcome in a patient with glioblastoma multiforme after receiving high-dose methotrexate

Samantha Price, PharmD

Hematology/Oncology Pharmacist, West Virginia University Hospitals One Medical Center Drive Morgantown, WV 26506, USA, prices{at}wvuh.com

William Harless, MD PhD

West Virginia University Section of Hematology/Oncology Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, PO Box 9162, Morgantown, WV 26506-9162, USA

Somi Rikhye, MD MPH

West Virginia University Section of Internal Medicine Morgantown, WV 26506-9162, USA

Ramin Altaha, MD

West Virginia University Section of Hematology/Oncology Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, PO Box 9162, Morgantown, WV 26506-9162, USA

The most common adult primary brain tumor is glioblastoma multiforme (GBM). Current treatment is surgical resection, adjuvant radiation and chemotherapy, which can extend the median survival 20—36 weeks (Mansky et al. Central nervous system tumors. In Abraham J, Allegra CJ, Gulley J, eds. Bethesda Handbook of clinical oncology, 2nd edn. Philadelphia, Pennsylvania: Lippincott Williams and Wilkins, 2000: 440—2; Knox S. Intracranial tumors. In Pillot G, Chantler M, Magiera H, Peles S, et al., eds. The Washington Manual Hematology and Oncology Subspecialty Consult. Philadelphia, Pennsylvania: Lippincott Williams and Wilkins, 2004: 204—6.). But treatment efficacy is limited, mandating the exploration of more effective treatments. We report on a patient with GBM treated as per a clinical protocol with high-dose methotrexate (12 g/m2), who expired within hours after the initiation of treatment secondary to transtentorial herniation. Although it is not completely clear what caused the patient's herniation, we think that high-dose methotrexate therapy may have played a crucial role. We suggest that high-dose methotrexate should be used cautiously in patients with GBM. J Oncol Pharm Practice (2008) 14: 57—60.

Key Words: methotrexate • glioblastoma multiforme • neurotoxicity


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