Methotrexate
The 1948 antifolate that produced the first chemotherapy remissions in childhood leukaemia and the first cure of a solid tumour; still essential in ALL, lymphoma, osteosarcoma and CNS lymphoma.
Farber (1948) with aminopterin; methotrexate cured choriocarcinoma (1956). Roles: ALL maintenance and CNS prophylaxis (intrathecal), high-dose regimens in osteosarcoma (MAP), PCNSL and Burkitt/DLBCL CNS prophylaxis, GTN, head and neck and bladder (MVAC). Toxicities: mucositis, nephrotoxicity (high dose; glucarpidase rescue), hepatotoxicity, pneumonitis. Also the standard DMARD in rheumatoid arthritis and used in ectopic pregnancy.
- Medicare
- Part B or Part D
Oral anticancer drug with an injectable equivalent used for the same indication, so Medicare covers the oral form under Part B (the oral anticancer drug benefit) as well as under Part D; the pharmacy bills whichever applies. High-dose IV methotrexate is Part B and usually inpatient (Part A).
- Commercial insurance
- covered on label
Multi-source generic on low-cost tiers; usually no prior authorisation. Cash prices without insurance are modest.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B) · Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
- Notes
- Long-established generic: never subject to a technology appraisal; funded routinely through hospital formularies and NHS England systemic anti-cancer therapy protocols.
- NHS England
- Routinely funded for the appraised indication (or via managed access)
Sources: NICE search: methotrexate. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 1953 | ALL, choriocarcinoma, and later osteosarcoma, breast, head and neck, lung, lymphoma, mycosis fungoides |
Trials
topRecruiting now (live from ClinicalTrials.gov)
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Latest papers
topQuery for this drug: (TITLE:"Methotrexate" OR ABSTRACT:"Methotrexate" OR TITLE:"Trexall" OR ABSTRACT:"Trexall" OR TITLE:"Otrexup" OR ABSTRACT:"Otrexup" OR TITLE:"Xatmep" OR ABSTRACT:"Xatmep") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Methotrexate, not a curated reading list.