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Care During Chemotherapy and Beyond

Pemetrexed

(pem-a-trex-ed)

Trade Names: Alimta®

Alimta is the trade name for 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 Pemetrexed Works" section below).

What Pemetrexed Is Used For

  • Pemetrexed is used in the treatment of malignant mesothelioma
  • Locally advanced or metastatic nonsquamous non-small 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

  • Pemetrexed is given as an infusion into the vein (intravenous, IV).
  • Patients treated with pemetrexed will usually require folic acid and vitamin B12 supplementation to reduce treatment related side effects.
  • The amount of pemetrexed 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 exact dose and schedule.

Side Effects

Important things to remember about the side effects of pemetrexed:

  • Most people do not experience all of the pemetrexed side effects listed.
  • Pemetrexed side effects are often predictable in terms of their onset, duration, and severity.
  • Side effects are almost always reversible and will go away after treatment is complete.
  • Pemetrexed side effects will improve after therapy is complete.
  • Pemetrexed side effects may be quite manageable. There are many options to minimize or prevent the side effects of pemetrexed.

The following side effects are common (occurring in greater than 30%) for patients taking pemetrexed:

These side effects are less common side effects(occurring in about 10-29%) of patients receiving pemetrexed:

Your fertility, meaning your ability to conceive or father a child, may be affected by pemetrexed. 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.

Precautions

  • Before starting pemetrexed 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 ibuprofen unless your doctor specifically permits this.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking pemetrexed.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (pemetrexed 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 pemetrexed. 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.

Self-Care Tips

  • Folic acid supplementation should be started before you first dose of pemetrexed, continued during your course of therapy, and should continue until 21 days after your last dose of pemetrexed. Vitamin B12 is to be given 1 week before your first dose of pemetrexed, with doses of vitamin B12 every 9 week thereafter. Folic acid and vitamin B12 are used to minimize some of the side effects of pemetrexed.
  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • 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.
  • 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 While Taking Pemetrexed

You will be checked regularly by your health care professional while you are taking pemetrexed 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 the 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 in the 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.

Pemetrexed belongs to the class of chemotherapy drugs called antimetabolites. Antimetabolites are very similar to normal substances within the cell. When the cells incorporate substances like pemetrexed into themselves during growth, the cells lose the ability to divide. Antimetabolites are cell-cycle specific meaning they act of the cells at very specific phases in the cells' replication cycle. Antimetabolites are classified according to the substances with which they interfere. Pemetrexed is classified as an antifolate antimetabolite. Pemetrexed exerts its chemotherapeutic effect by disrupting production of folate which is essential for cell replication. This action also effects normal cells which can cause significant side effects in the body, such as low blood cell counts, nausea, and vomiting. These complications and side effects of pemetrexed can be reduced by using folic acid and vitamin B12 supplementation.

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.

References:

  • Alimta® (Pemetrexed) [package insert on the Internet]. Indianapolis, IN. Lilly USA, LLC. Feb 2015. [Updated June 18, 2017; Cited June 18, 2017]. Available from: http://uspl.lilly.com/alimta/alimta.html#pi
  • Pemetrexed. Lexicomp Online® [Updated June 18, 2017; Cited June 18, 2017]. Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc.

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