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Beyond DHFR inhibition, MTX and the polyglutamate forms impede de novo purine synthesis and thymidylate synthase, intensifying the cytotoxic effects that affect cell proliferation and growth ( Despite the efficacy of MTX, related toxicity has been reported in several studies, including liver toxicity (increase of liver function, risk of liver failure), kidney toxicity (renal impairment, renal failure), hematological toxicity (pancytopenia, myelosuppression, leukopenia, neutropenia, megaloblastic anemia), pulmonary toxicity (wheezing, asthma), dermatological toxicity (skin lesion), and gastrointestinal (GI) effects (diarrhea, nausea, vomiting, etc

The use of PPIs can increase plasma gastrin levels by 35 times, dependent on treatment duration, necessitating suspension before testing, yet the 2024 guidelines do not address this [18]

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DNA was stored in 80 C and TL assays were performed within 2 weeks of DNA extraction

Vitamin C supports many important biological functions through its action as an electron donor ( Table 1 ) have consistently shown that patients with cancer have lower mean plasma vitamin C status than healthy controls (Torun et al., 1995