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As MTX is chiefly excreted by the kidneys, MTX-mediated renal injury leads to delayed clearance of MTX, causing persistent elevation of plasma MTX level, leading to ineffectual rescue by leucovorin and obvious augmentation of MTXs related toxicities [12]

Clinically meaningful weight loss occurs gradually over several months of treatment combined with lifestyle modifications, so first-week results are not indicative of long-term outcomes