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Methotrexate is a folate analogue metabolic inhibitor that functions as an antineoplastic agent. It works by competitively inhibiting the enzyme dihydrofolate reductase (DHFR), which prevents the formation of tetrahydrofolate, a necessary cofactor for the synthesis of thymidylate and purine nucleotides required for DNA replication. In the specific clinical trial context led by the Eastern Cooperative Oncology Group (ECOG), high-dose methotrexate was investigated for the treatment of newly diagnosed glioblastoma multiforme (GBM). This regimen (NCT00082797) utilized systemic high-dose intravenous methotrexate followed by leucovorin calcium rescue to minimize systemic toxicity while attempting to achieve therapeutic concentrations within the central nervous system to treat primary brain tumors.
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