Due to fedratinib's significant GI side effect profile and the logistical difficulty of measuring thiamine levels, clinicians should proactively provide patients with thiamine supplements, anti-emetics, and anti-diarrheal therapies. Instructing patients to take the drug with food can also help mitigate GI toxicity.

Beyond immediate kidney rescue, glucarpidase's crucial role is preserving a patient's eligibility for subsequent methotrexate cycles. This allows them to complete their planned, first-line cancer treatment, giving them the best chance at remission—a benefit not captured by short-term outcomes.

In muscle-invasive bladder cancer, cisplatin ineligibility is frequently due to renal insufficiency caused by large, aggressive tumors obstructing the ureter. This redefines this patient group as having more advanced local disease, rather than simply being unfit for chemotherapy, explaining their poor outcomes with surgery alone.

The rapid and successful rollout of complex bispecific therapies into community settings is primarily driven by enhanced nursing staff skills and protocols for risk stratification. This combination allows for safe outpatient administration, preventing hospital admissions and broadening patient access beyond large academic centers.

Clinical evidence suggests a critical 48- to 60-hour window for administering glucarpidase post-methotrexate infusion. Once irreversible organ injury occurs, the drug's benefit is significantly reduced. This narrow timeframe underscores the need for rapid diagnosis and intervention.

The mtxpk.org pharmacokinetic tool visualizes a patient's predicted versus actual methotrexate clearance. A significant deviation from the ideal curve provides objective, data-driven evidence for delayed clearance, helping clinicians justify the early use of costly glucarpidase to hospital administrators.

With highly effective neoadjuvant therapies now available, the surgeon's role in muscle-invasive bladder cancer is evolving. They are moving from being the primary decider and treater to being a key manager of a 'perioperative bundle,' where their first goal is often to get patients to medical oncology for systemic treatment.

When treating testicular DLBCL, administering systemic methotrexate for CNS prophylaxis before testicular radiation is crucial. Reversing the order can cause a severe skin reaction known as radiation recall, a critical and potentially dangerous complication.

Standard creatinine tests are misleading in cancer patients, often overestimating true kidney function. This leads to incorrect risk assessment and methotrexate dosing. Using alternative markers like cystatin C provides a more accurate baseline, enabling safer treatment protocols.