Challenging the clinical relevance of folinic acid over rescue after high dose methotrexate (HDMTX)

The importance of adequate methotrexate and adequate folinic acid rescue doses in the treatment of primary brain lymphoma

“…The clinical significance of "over rescue" by too much folinic acid after HDMTX is neither evidence based nor has been found to be supported by the published claims of its existence [4]. Significantly no published series can be found that documents a reduced prognosis with increased folinic acid rescue.…”

Delivering modern anticancer therapies in low‐ and middle‐income settings: We can be evidence based

“…seem warranted 11 and, as Cohen points out in his paper, may lead to unnecessary neurotoxicity. Nonetheless, as the authors suggest, perhaps extra doses of folinic acid could be given only to those patients who experience elevated creatinine levels.…”

“…Are the authors unwittingly courting excessive relapse in these patients? Early folinic acid rescue clearly affects drug efficacy and compromises outcomes (Figure ), but the concern that high‐dose or prolonged folinic acid rescue (initiated after the initial period of MTX exposure) can compromise outcomes does not seem warranted and, as Cohen points out in his paper, may lead to unnecessary neurotoxicity. Nonetheless, as the authors suggest, perhaps extra doses of folinic acid could be given only to those patients who experience elevated creatinine levels.…”

Reply to: methotrexate administration directly into the fourth ventricle in children with malignant fourth ventricular brain tumors: a pilot clinical trial

“…We would suggest a dose of 760 mg folinic acid after 12 g/m 2 MTX. The concept of ''over'' rescue has be discredited and should not deter the use of this valuable non toxic approach [3]. …”