In February 2004, the U.S.
Food and Drug Administration (FDA) approved pemetrexed for treatment of malignant pleural mesothelioma, a type of tumor of the
mesothelium, the thin layer of tissue that covers many of the internal organs, in combination with
cisplatin[8] for patients whose disease is either unresectable or who are not otherwise candidates for curative surgery.[9] In September 2008, the FDA granted approval as a first-line treatment, in combination with cisplatin, against locally advanced and metastatic
non-small cell lung cancer (NSCLC) in patients with non-squamous histology.[10][11][2]
Carboplatin
Pemetrexed is also recommended in combination with
carboplatin and
pembrolizumab for the first-line treatment of advanced non-small cell lung cancer.[12][13] However, the relative efficacy or toxicity of pemetrexed-cisplatin versus pemetrexed-carboplatin has not been established beyond what is generally thought about cisplatin or carboplatin doublet drug therapy.[14]
Supplementation
Patients are recommended to take
folic acid and
vitamin B12 supplement even if levels are normal when they are on pemetrexed therapy.[15][2] (In clinical trials for mesothelioma, folic acid and B12 supplementation reduced the frequency of adverse events.) It is also recommended for patients to be on a
glucocorticoid (e.g.
dexamethasone) on the day prior, day of, and day after pemetrexed infusion to avoid skin rashes.[2]
Side effects
Pemetrexed, whether used alone or in combination with cisplatin, has these side effects:[2]
Oral
mucositis (mouth, throat, or lip sores).
Oral ulcers can be mitigated by proper oral hygiene, including rinsing of the mouth with salt water following consumption of food or drink.[17]
Loss of appetite
Skin
rash. Physician-prescribed glucocorticoids administered on the day prior, day of, and day after infusion typically avoid skin rashes.
In the United States, as of 2015[update], each vial of the medication costs between US$2,623 and US$3,100.[20]
Brand names
In February 2020, Pemfexy was approved for use in the United States.[21]
Research
A Phase III study showed benefits of maintenance use of pemetrexed for non-squamous NSCLC.[22] Activity has been shown in malignant peritoneal mesothelioma.[23]
^Rossi A, Ricciardi S, Maione P, de Marinis F, Gridelli C (November 2009). "Pemetrexed in the treatment of advanced non-squamous lung cancer". Lung Cancer. 66 (2): 141–149.
doi:
10.1016/j.lungcan.2009.06.006.
PMID19577816.
^Ettinger DS, et al.
"Non-small Cell Lung Cancer V.1.2007"(PDF). NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network (NCCN). Archived from
the original(PDF) on 23 March 2007.
^Carteni G, Manegold C, Garcia GM, Siena S, Zielinski CC, Amadori D, et al. (May 2009). "Malignant peritoneal mesothelioma-Results from the International Expanded Access Program using pemetrexed alone or in combination with a platinum agent". Lung Cancer. 64 (2): 211–218.
doi:
10.1016/j.lungcan.2008.08.013.
PMID19042053.