Higher Doses of Methotrexate Dramatically Improve Survival in Some Lymphoma Patients

High-dose chemotherapy with methotrexate offers up to a fivefold increase in survival to patients with primary central nervous system lymphoma. Researchers at Memorial Sloan-Kettering Cancer Center found that using significantly more methotrexate, while adding drugs that penetrate the blood-brain barrier, improved disease control and survival in patients with newly diagnosed cancer.

More than 90% of the 52 patients studied responded to the chemotherapy, and median overall survival was 5 years, compared to approximately 1 year with the current standard of care—radiotherapy alone.

A Boost to Radiotherapy

Clinicians have increased their use of methotrexate, although no optimal regimen has been adopted and researchers have been testing different doses, said study leader, neurologist Lauren Abrey, MD.

Radiotherapy can help some patients; however, when used with chemotherapy, radiation benefited younger patients in this study, but did not offer longer survival to patients over age 60 years—an important finding since the elderly constitute one-half of the patient population.

“One misconception is that it is more difficult or dangerous to treat older patients with chemotherapy, and that it’s easier to use radiation,” said Dr. Abrey. “We would argue just the opposite. Our older patients tolerate this chemotherapy remarkably well without the cognitive dysfunction associated with whole-brain radiation therapy.”