How it is administered

Methotrexate is available in several forms and can be given:

• Orally as tablets or as an oral solution (such as Jylamvo or Xatmep)
• By injection, which can be administered intravenously (into a vein), intramuscularly (into a muscle), subcutaneously (under the skin), or intrathecally (into the spinal fluid, for certain cancers)

The specific route, dose, and frequency depend on the disease being treated, the patient's age, and other factors. For blood cancers, methotrexate is often part of a combination chemotherapy regimen and may be given weekly or as part of a cycle.

How it works

Methotrexate works by inhibiting an enzyme called dihydrofolate reductase. This enzyme is important for the production of DNA and new cells. By blocking this enzyme, methotrexate interferes with the ability of cells to make DNA, repair themselves, and replicate.

Cancer cells, especially those in blood cancers like leukemia and lymphoma, grow and divide much more quickly than normal cells. Methotrexate targets these rapidly dividing cells, slowing or stopping their growth. This action is especially effective in blood cancers, where the goal is to reduce the number of abnormal cells in the blood, bone marrow, or lymphatic system.

Because methotrexate also affects normal cells that divide quickly (like those in the mouth, stomach, and hair), some side effects are related to its impact on these healthy cells.

Who Should take it

Methotrexate is used to treat various types of blood cancers, including:

• Acute lymphoblastic leukemia (ALL) in both adults and children, as part of a combination chemotherapy maintenance regimen
• Non-Hodgkin lymphoma (including relapsed or refractory cases)
• Mycosis fungoides (a type of cutaneous T-cell lymphoma)
• Meningeal leukemia (for prevention and treatment, via intrathecal administration)

It is also used for other conditions such as rheumatoid arthritis, juvenile idiopathic arthritis, and severe psoriasis, but in the context of blood cancers, its primary role is as a chemotherapy agent. The decision to use methotrexate is made by your healthcare team based on your specific diagnosis, treatment plan, and overall health.

Who should not take it

Methotrexate should not be taken by:

• Pregnant women who are being treated for non-cancerous conditions, as it can cause severe harm to an unborn baby. For cancer treatment, it may still be used if the benefits outweigh the risks, but this is a decision made by your doctor.
• Anyone with a history of severe allergic reactions to methotrexate.
• People with certain severe liver or kidney problems, unless the benefits outweigh the risks.
• Patients with active, serious infections, as methotrexate can further suppress the immune system.

Your doctor will review your medical history and current medications to ensure methotrexate is safe for you.

Commonly used with

In blood cancers, methotrexate is often used as part of a combination chemotherapy regimen. This means it is given with other chemotherapy drugs such as:

• Vincristine
• Doxorubicin
• Cyclophosphamide
• Cytarabine
• Mercaptopurine
• Leucovorin (as a 'rescue' agent to reduce toxicity after high-dose methotrexate)

The specific combination depends on the type of cancer and the treatment protocol.

Commonly tested with

Methotrexate is commonly tested in combination with other chemotherapy agents in clinical trials for blood cancers. These may include:

• Vincristine
• Doxorubicin
• Cyclophosphamide
• Cytarabine
• Mercaptopurine
• Leucovorin (used to help protect normal cells from methotrexate's effects)

It is also tested with supportive care medications to manage side effects, such as anti-nausea drugs and antibiotics to prevent infection.