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The prognosis remains dismal, with a median survival of 4\u20138 weeks. Methotrexate (MTX), the current standard treatment, is often compromised by resistance through dihydrofolate reductase (DHFR) upregulation and by neurotoxicity at high doses, underscoring the need for alternative therapeutic approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An MTX-resistant subline (R-MM46) was established from a murine mammary carcinoma. Resistance was confirmed by increased DHFR activity, enhanced drug efflux, and apoptosis resistance, and validated in an LC mouse model. Metabolic alterations were assessed by measuring phosphoribosyl pyrophosphate (PRPP), hypoxanthine-guanine phosphoribosyltransferase (HGPRT), and thymidine kinase (TK). The therapeutic efficacy of 6-thioguanine (6-TG), which targets the salvage pathway, was evaluated in vivo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>R-MM46 cells exhibited a 6\u20137-fold increase in DHFR activity, together with upregulation of P-glycoprotein and Bcl-2. In the LC mouse model inoculated with R-MM46 cells, MTX treatment failed to prolong survival. R-MM46 cells demonstrated PRPP accumulation and increased HGPRT and TK activity, consistent with activation of the salvage pathway. Oral 6-TG significantly extended survival, with the greatest benefit observed when administered sequentially 2\u20136\u00a0h after MTX.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sequential 6-TG administration capitalizes on salvage pathway activation in MTX-resistant LC and may represent a promising therapeutic strategy to overcome MTX resistance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-025-05321-5","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:33:58Z","timestamp":1762176838000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Investigation of 6-thioguanine as a strategy to overcome methotrexate resistance in a mouse model of leptomeningeal carcinomatosis"],"prefix":"10.1007","volume":"176","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4400-7673","authenticated-orcid":false,"given":"Hidemitsu","family":"Nakagawa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5806-7801","authenticated-orcid":false,"given":"Yoshihiro","family":"Yui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsuyoshi","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masakazu","family":"Tamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masanobu","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Kawaichi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"5321_CR1","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/s11910-025-01412-y","volume":"25","author":"U Sener","year":"2025","unstructured":"Sener U, Wilcox JA, Boire AA (2025) Leptomeningeal disease: current approaches and future directions. 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