pemetrexed disodium at a glance
Medicine class
Cytotoxic antifolate chemotherapy
Main uses
Selected advanced non-squamous non-small-cell lung cancers and unresectable malignant pleural mesothelioma
Supportive treatment
Folic acid, vitamin B12 and a corticosteroid are used to reduce important toxicities
What is pemetrexed disodium used for?
UK-licensed uses for the selected product are:
With cisplatin for previously untreated, unresectable malignant pleural mesothelioma.
With cisplatin as first-line treatment of locally advanced or metastatic non-small-cell lung cancer that is not predominantly squamous.
On its own as maintenance treatment of locally advanced or metastatic non-squamous non-small-cell lung cancer that has not progressed after platinum-based chemotherapy.
On its own as second-line treatment of locally advanced or metastatic non-squamous non-small-cell lung cancer.
How does pemetrexed disodium work?
Pemetrexed enters cells and is converted into forms that remain inside them. It blocks several folate-dependent enzymes, including thymidylate synthase, dihydrofolate reductase and GARFT, reducing the building blocks required to make DNA and RNA. This particularly affects rapidly dividing cells.
pemetrexed disodium preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 25 mg/mL, 100 mg, 500 mg
How to take pemetrexed disodium
Pemetrexed is prepared and given by intravenous infusion in a specialist setting. Attend scheduled blood tests and treatment appointments, and take prescribed folic acid and corticosteroid exactly as directed; vitamin B12 is given by injection. Tell the team before treatment if supportive medicines have been missed.
It is not taken by mouth.
Food does not affect the infusion, although accompanying tablets may have separate instructions.
Do not start vitamins, painkillers or indigestion medicines without checking with the cancer team.
pemetrexed disodium side effects
Common or expected effects
- Reduced white cells, red cells or platelets
- Infection or sore throat
- Nausea, vomiting, diarrhoea or reduced appetite
- Sore or inflamed mouth
- Tiredness
- Rash, itching or skin peeling
- Changes in kidney blood tests
- Taste changes, dizziness or peripheral nerve symptoms
Get urgent medical advice
- Fever with low white-cell counts, severe infection or sepsis
- Significant bleeding or severe bone-marrow suppression
- Severe allergic reaction
- Acute kidney injury
- Pulmonary embolism or inflammatory lung disease
- Serious blistering skin reactions
- Serious cardiac or cerebrovascular events
pemetrexed disodium in pregnancy
Pemetrexed should be avoided during pregnancy unless a specialist considers it clearly necessary because serious fetal harm is suspected and animal studies showed reproductive toxicity. Tell the oncology team immediately about pregnancy or plans to conceive. Effective contraception is required during treatment and for six months afterwards for women who could become pregnant; men should avoid fathering a child during treatment and for three months afterwards.
pemetrexed disodium while breastfeeding
Breastfeeding is contraindicated during pemetrexed treatment because transfer into human milk is unknown and harm to the infant cannot be excluded. Discuss feeding options with the oncology and maternity teams.
pemetrexed disodium interactions
Give the oncology team a complete list of prescribed, over-the-counter and complementary products.
NSAIDs, including ibuprofen and high-dose aspirin
They may reduce renal clearance of pemetrexed and increase blood, gastrointestinal and other toxicities; the team should advise whether and when they must be withheld.
Proton-pump inhibitors, including omeprazole and lansoprazole
OAT3 inhibition may delay pemetrexed clearance, so concurrent use requires review and caution.
Nephrotoxic medicines, including aminoglycosides, loop diuretics, platinum compounds and ciclosporin
Reduced pemetrexed clearance and renal toxicity may occur; renal function may need closer monitoring.
Common questions about pemetrexed disodium
Answers are fully visible for fast scanning and source review.
What cancers is pemetrexed disodium licensed to treat?
It is licensed for specified non-squamous non-small-cell lung cancers and, with cisplatin, previously untreated unresectable malignant pleural mesothelioma.
Is pemetrexed disodium used for squamous lung cancer?
The selected product’s lung-cancer indications exclude predominantly squamous histology.
How is pemetrexed disodium given?
It is prepared by healthcare professionals and given as an intravenous infusion in a specialist cancer setting.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.