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Monitoring parameters: - Urine pH (every 68 hours or per protocol) - Serum creatinine - Methotrexate plasma levels - Electrolytes (watch for metabolic alkalosis, hypokalemia) If urine pH is suboptimal: - Increase sodium bicarbonate infusion - Consider IV bolus doses - Add acetazolamide in selected cases Relation to rescue therapy: Urinary alkalinization does not replace Leucovorin rescue, but it is essential to prevent toxicity and ensure proper drug elimination

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There are a range of effective treatments out there, and increasingly people use multiple treatments in combination and succession