Medicine Overview of Pemetrex 500mg/5ml Injection
Pemetrex is used in the treatment of non-small cell lung cancer and malignant pleural mesothelioma.
Pemetrex is given as an injection by a qualified medical professional. Your doctor will decide what dose is necessary and how often you need to take it. This will depend on what you are being treated for and may change from time to time. You should take it exactly as your doctor has advised. Taking it in the wrong way or taking too much can cause very serious side effects. It may take several weeks or months for you to see or feel the benefits but do not stop taking it unless your doctor tells you to.
The most common side effects of this medicine include nausea, vomiting, loss of appetite, and hair loss. This medicine may reduce the number of blood cells (decrease red blood and white blood cells) in your blood, thereby, increasing the susceptibility to infections. Regular blood tests are required to check your blood cells along with heart, liver and blood uric acid levels.
Before taking it, tell your doctor if have heart disease, liver, or kidney problems or are taking any medicines to treat infections. Many other medicines can affect, or be affected by, this medicine so let your doctor know all medications you are using.This medicine is not recommended during pregnancy or while breastfeeding. Use of effective contraception by both males and females during treatment is important to avoid pregnancy.
- Non-small cell lung cancer
- Malignant pleural mesothelioma
- Nausea
- Vomiting
- Sore throat
- Loss of appetite
- Stomatitis (Inflammation of the mouth)
- Hair loss
- Low blood platelets
- Rash
- Fatigue
- Anemia (low number of red blood cells)
- Diarrhea
- Decreased white blood cell count (neutrophils)
- Neuropathy
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Use a reliable contraceptive method to prevent pregnancy while you are taking this medicine.
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Inform your doctor immediately if you notice any signs of infection such as fever, sore throat, rash or severe diarrhea.
IV Preparation
Aseptically reconstitute with 20 mL of 0.9% NaCl (preservative free) to give a 25 mg/mL solution
Gently swirl until completely dissolved; resulting solution is clear and ranges in color from colorless to yellow/green-yellow without adversely affecting quality
Aseptically dilute required dose to 100 mL with 0.9% NaCl (preservative free)
IV Administration
Infuse over 10 min
Intravenous
Malignant Pleural Mesothelioma
Indicated for mesothelioma in combination with cisplatin in patients whose disease is unresectable or are not candidates for curative surgery
Combination use with cisplatin: 500 mg/m² IV over 10 minutes on Day 1 of each 21-day cycle; administer cisplatin (75 mg/m² IV over 2 hr) 30 minutes after end of premetrexed infusion
Nonsquamous Non-Small Cell Lung Carcinoma
Indications
Initial treatment: In combination with cisplatin for initial treatment with locally advanced or metastatic nonsquamous NSCLC
Maintenance: Locally advanced or metastatic nonsquamous NSCLC in patients whose disease has not progressed after 4 cycles of platinum-based first-line chemotherapy
After prior chemotherapy: As a single agent of locally advanced or metastatic nonsquamous NSCLC after prior chemotherapy
Single-agent use: 500 mg/m² IV infusion over 10 minutes on Day 1 of each 21-day cycle
Combination use with cisplatin: 500 mg/m² IV over 10 minutes on Day 1 of each 21-day cycle; administer cisplatin (75 mg/m² IV over 2 hr) 30 minutes after end of premetrexed infusion
Premedication Regimen
Folic acid: 400-1000 mcg PO qDay beginning 7 days before first pemetrexed dose; continue during the full course of therapy and for 21 days after the last dose
Vitamin B12: 1 mg IM beginning 1 week before first pemetrexed dose and repeat every 3 cycles thereafter; subsequent doses may be administered on the same day as pemetrexed
Do not substitute PO B12 for IM (see Cautions)
Dexamethasone: 4 mg PO BID on the day before, day of, and day after pemetrexed administration treatment to help prevent skin rash
Dosage Modifications
If nadir ANC <500/mm³ & nadir platelets >50,000/mm³
Adjust to 75% of previous dose (both drugs)
If nadir platelets <50,000/mm³ regardless of nadir ANC
Adjust to 50% of previous dose (both drugs)
Any Grade 3 or 4 toxicities except mucositis
Adjust to 75% of previous dose (both drugs)
Any diarrhea requiring hospitalization
Adjust to 75% of previous dose (both drugs)
Grade 3 or 4 mucositis
Adjust pemetrexed to 50% of previous dose
CTC Grade 2
Adjust Cisplatin to 50% of previous dose
Safety and efficacy not established
Renal impairment:
CrCl (ml/min) Dosage Recommendation
<45 Usage is not recommended.
Monitor CBC, platelet counts, and CrCl for nadir and recovery before each cycle. Periodic hepatic monitoring Premedication with folate and vitamin B12 are recommended as prophylaxis against haematological and GI toxicity during treatment. Pre-treatment with a corticosteroid also reduces the incidence and severity of skin reactions. Caution when used in renal or hepatic impairment. Not recommended for use in pregnancy.
Lactation: not safe
>10%
Nausea (84%),Fatigue (80%),Pulmonary dyspnea (66%),Neutropenia (58%),Vomiting (58%),Leukopenia (55%),Constipation (44%),Chest pain (40%),Anorexia (35%),Anemia (33%),Pharyngitis (28%),Stomatitis (28%),Thrombocytopenia (27%),Diarrhea without colostomy (26%),Rash/desquamation (22%),Fever (17%),Neuropathy/sensory (17%),Creatinine elevation (16%),Mood alteration/depression (14%),Infection without neutropenia (11%)
1-10%
Dehydration, thrombosis/embolism (7%),Dysphagia/esophagitis/odynophagia (6%),Infection with Grade 3 or Grade 4 neutropenia (6%),Neutropenia-other (3%),Allergic reaction/hypersensitivity (2%),Renal failure (2%),Febrile neutropenia (1%)
<1%
Esophagitis,Arrhythmia,Motor neuropathy,Febrile neutropenia,Erythema multiforme
Potentially Fatal: Acute renal failure.
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