Pralatrexate (Folotyn)

Used as a single agent for patients with relapsed or refractory peripheral T cell lymphoma.

Synthetic 10-deaza-aminopterin antifolate.

Inhibits the enzyme dihydrofolate reductase and has antitumor effects by accumulating polyglutamate metabolites in tumor cells.

It is suggested that it selectively enters and accumulates in cells expressing reduced folate carrier-1 cell surface receptors, which is commonly overexpressed on cancer cells.

Pralarexate In Patients with Relapsed Or refractory Peripheral T-cell Lymphoma (PROPEL) study treated patients with 30 mg three square IV weekly in seven-week cycles: of 109 of evaluable patients 27% responded with a median duration of response of 9.4 months.

Most common adverse events are thrombocytopenia (33%), mucositis (21%), neutropenia ( 20%), and anemia (17%).

Indication for use is based on its overall response rate, because improvement in progression free survival or all rural survival has not been documented.

Higher baseline methylmalonic acid levels are associated with more severe mucositis in patients receiving this drug (Pro B).

Dose of 30 mg/m2 IV over 3-5 minutes once weekly for 6 weeks in 7 week cycles.

Patients should be given vitamin B12 1 mg IM not more than 10 days prior to treatment and every 8-10 weeks thereafter, as well as folic acid 1-1.25 mg orally daily.

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