SALVAGE TRIAL OF TRIMETREXATE-LEUCOVORIN FOR THE TREATMENT OF CEREBRAL TOXOPLASMOSIS IN PATIENTS WITH AIDS

The clinical efficacy of trimetrexate, a dihydrofolate reductase inhib itor with potent in vitro antitoxoplasma activity, was assessed in 9 s ulfonamide-intolerant patients with AIDS and biopsy-proven cerebral to xoplasmosis. The 9 patients were treated for 28-149 days with trimetre xate (30-280 mg/m2/day) plus leucovorin (20-90 mg/m2 every 6 h). Radio graphic responses were documented in 8 patients, and clinical response s in 5 patients. Despite continued therapy, all patients deteriorated clinically and radiographically within 13-109 days of their initial im provement. Trimetrexate at very high doses for extended periods was no t associated with serious toxicity. Trimetrexate alone had dramatic bu t transient activity in sulfonamide-intolerant patients and thus is no t adequate as single-agent therapy for AIDS-associated toxoplasmosis.