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These include [4] : Dehydration and electrolyte imbalance: Severe and repeated vomiting causes significant loss of fluids and essential electrolytes

As discussed in section III.G.3

Importantly, these results suggest that multiple strategies may evolve to escape drug pressure, despite the evolutionary bottleneck that occurs during the DTP phase when a bulk population is challenged with anticancer therapies

3134 MTX can create DNA adducts upon cell entry, resulting in the production of ROS and activation of p53, 35 which is a well-known tumor suppressor gene and has been linked to MTX-induced apoptosis