Care During Chemotherapy and Beyond
Trade names: Alimta®
Alimta is the trade name for the generic drug name Pemetrexed. In some cases,
health care professionals may use the trade name Alimta when referring to the generic
drug name Pemetrexed.
Drug type: Pemetrexed is an anti-cancer ("antineoplastic"
or "cytotoxic") chemotherapy drug. Pemetrexed is classified as an "antimetabolite".
(For more detail, see "How this drug works" section below.)
What Pemetrexed is used for:
- Pemetrexed is used in the treatment of malignant mesothelioma
- Locally advanced or metastatic nonsquamous nonsmall cell lung cancer.
Note: If a drug has been approved for one use, physicians may elect to use
this same drug for other problems if they believe it may be helpful.
- How Pemetrexed is given:
- Premetrexed is given as an infusion into the vein (intravenous, IV).
- Patients treated with premetrexed will usually require folic acid and vitamin B12
supplementation to reduce treatment related side effects.
- The amount of premetrexed that you will receive depends on many factors, including
your height and weight, your general health or other health problems, and the type
of cancer or condition being treated. Your doctor will determine your dose
Side effects of Pemetrexed:
Important things to remember about the side effects of premetrexed:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the
effectiveness of the medication.
The following side effects are common (occurring in greater than 30%) for patients
- Low white blood cell count. (This can put you at increased risk for infection.)
- Low red blood cell count (Anemia).
- Nausea and vomiting
- Poor appetite
- Shortness of breath
- Chest pain
These side effects are less common side effects (occurring in about 10-29%) of patients
- Low platelet count. (This can put you at increased risk for bleeding.)
- Increase in blood test creatinine.
- Flu-like symptoms: Fever, chills, generalized aches and pains, headache, poor appetite.
- Mouth sores
- Numbness or tingling of hands or feet
- Rash, skin irritation
Nadir: 8-10 days
Your fertility, meaning your ability to conceive or father a child, may be affected
by premetrexed. Please discuss this issue with your health care provider.
Not all side effects are listed above. Some that are rare (occurring in less than
10% of patients) are not listed here. However, you should always inform your
health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
Contact your health care provider immediately, day or night, if you should
experience any of the following symptoms:
- Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
The following symptoms require medical attention, but are not an emergency.
Contact your health care provider within 24 hours of noticing any of the following:
- Nausea (interferes with ability to eat and unrelieved with prescribed medication).
- Vomiting (vomiting more than 4-5 times in a 24 hour period).
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools.
- Blood in the urine.
- Pain or burning with urination.
- Extreme fatigue (unable to carry on self-care activities).
- Constipation unrelieved by laxative use.
- Signs of infection such as redness or swelling, pain on swallowing, coughing up
mucous, or painful urination.
- Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst,
dry mouth, dark and decrease amount of urine, or dizziness.
- Depressed (interfering with your ability to carry on your regular activities).
Always inform your health care provider if you experience any unusual symptoms.
- Before starting premetrexed treatment, make sure you tell your doctor about any
other medications you are taking (including prescription, over-the-counter, vitamins,
herbal remedies, etc.). Do not take aspirin, or products containing
aspirin unless your doctor specifically permits this.
- Do not take non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprophen unless
your doctor specifically permits this.
- Do not receive any kind of immunization or vaccination without your doctor's approval
while taking premetrexed.
- Inform your health care professional if you are pregnant or may be pregnant prior
to starting this treatment. Pregnancy category D (premetrexed may be hazardous
to the fetus. Women who are pregnant or become pregnant must be advised of
the potential hazard to the fetus.)
- For both men and women: Do not conceive a child (get pregnant) while taking premetrexed.
Barrier methods of contraception, such as condoms, are recommended. Discuss with
your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed
- You may be at risk of infection so try to avoid crowds or people with colds and
those not feeling well, and report fever or any other signs of infection immediately
to your health care provider.
- Wash your hands often.
- You may be at risk of infection report fever or any other signs of infection immediately
to your health care provider.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and
eat small, frequent meals.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- Keep your bowels moving. Your health care provider may prescribe a stool softener
to help prevent constipation that may be caused by this medicine.
- For flu-like symptoms, keep warm with blankets and drink plenty of liquids.
There are medications that can help reduce the discomfort caused by chills.
- Acetaminophen may help relieve discomfort from fever, headache and/or generalized
aches and pains. However, be sure to talk with your doctor before taking it.
- If you experience symptoms or side effects, be sure to discuss them with your health
care team. They can prescribe medications and/or offer other suggestions that
are effective in managing such problems.
Monitoring and testing:
You will be checked regularly by your health care professional while you
are taking premetrexed to monitor side effects and check your response to therapy.
Periodic blood work to monitor your complete blood count (CBC) as well as the function
of other organs (such as your kidneys and liver) will also be ordered by your doctor.
How Pemetrexed works:
Cancerous tumors are characterized by cell division, which is no longer controlled
as it is in normal tissue. "Normal" cells stop dividing when they come
into contact with like cells, a mechanism known as contact inhibition. Cancerous
cells lose this ability. Cancer cells no longer have the normal checks and
balances in place that control and limit cell division. The process of cell
division, whether normal or cancerous cells, is through the cell cycle. The
cell cycle goes from the resting phase, through active growing phases, and then
to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt
cell division. Usually, the drugs work by damaging the RNA or DNA that tells
the cell how to copy itself in division. If the cells are unable to divide,
they die. The faster the cells are dividing, the more likely it is that chemotherapy
will kill the cells, causing the tumor to shrink. They also induce cell suicide
(self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle
specific. Chemotherapy drugs that affect cells when they are at rest are called
cell-cycle non-specific. The scheduling of chemotherapy is set based on the
type of cells, rate at which they divide, and the time at which a given drug is
likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing.
Unfortunately, chemotherapy does not know the difference between the cancerous cells
and the normal cells. The "normal" cells will grow back and be healthy but in the
meantime, side effects occur. The "normal" cells most commonly affected by
chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and
the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea,
and/or hair loss. Different drugs may affect different parts of the body.
Premetrexed belongs to the class of chemotherapy drugs called antimetabolites.
Antimetabolites are very similar to normal substances within the cell. When
the cells incorporate these substances into the cellular metabolism, they are unable
to divide. Antimetabolites are cell-cycle specific. They attack cells
at very specific phases in the cycle. Antimetabolites are classified according
to the substances with which they interfere.
- Antifolate: Premetrexed
- Folic acid antagonist: Methotrexate.
- Pyrimidine antagonist: 5-Fluorouracil, Foxuridine, Cytarabine, Capecitabine,
- Purine antagonist: 6-Mercaptopurine and 6-Thioguanine.
- Adenosine deaminase inhibitor: Cladribine, Fludarabine and Pentostatin.
Premetrexed exerts its chemotherapeutic effect by disrupting folate-dependent metabolic
processes essential for cell replication. This action also effects normal
cells which can cause significant side effects in the body, such as: low white,
red and platelet blood cell counts, nausea and vomiting. These complications
and side effects of premetrexed can be reduced by using folic acid and vitamin B-12
Note: We strongly encourage you to talk with your health care professional
about your specific medical condition and treatments. The information contained
in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org