Neurotoxic effects of the chemotherapeutic drug "methotrexate": a literature review.
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INTRODUCTION: Methotrexate (MTX) is currently considered the go-to drug in chemotherapy, although it possesses neurological dangers. In this review paper, research and records of MTX-induced neurotoxicity in different types of adult and pediatric cancers will be discussed. The general description and function of MTX are still not completely known. How biological ratios in the body fluctuate with low and high methotrexate doses are still unknown as well. Therefore, this is a hot topic for experts, especially those active in neuro-oncology research. Scientists and physicians are now using different protocols to understand, control, manage, and prevent MTX-neurotoxic events. AIM: By evaluating various studies, case reports, and clinical trials, this comprehensive review seeks to clarify the mechanisms underlying MTX-induced neurotoxicity, highlight potential strategies for prevention and management, and guide future research in mitigating the adverse neurological effects of MTX treatment. METHODS: Several databases were employed to gather this information, mainly PubMed. RESULTS: The precise mechanisms of MTX-induced neurotoxicity remain unclear. Multiple hypotheses suggest involvement of genes related to neurogenesis, but no definitive cause has been identified. Regular patient monitoring, long-term follow-up, variable therapies, and early MRI detection are recommended. CONCLUSION: Despite advancements, no longitudinal studies have conclusively determined effective strategies to prevent MTX-induced neurotoxicity. Demographic factors and cancer types do not consistently predict neurotoxicity. Future research should focus on genetic counseling prior to chemotherapy, targeted monitoring protocols, and long-term patient follow-up to better understand and mitigate the neurotoxic impacts of MTX. Pharmacokinetics and advanced neuroimaging techniques are also essential for improving patient outcomes.