Drug Overview
Pemetrexed is an anticancer drug used for the treatment of pleural mesothelioma (cancer affecting the outer covering of the lungs) and non-small cell carcinoma. Pemetrexed is either used as a single agent or in combination with other anticancer drugs to treat cancers that have spread to other parts of the body (metastatic cancers). The drug Pemetrexed was approved by the Food and Drug Administration (FDA) in February 2004. Read the article to know more about the indications, mechanism of action, side effects, uses, and complications of the drug Pemetrexed.
How Does Pemetrexed Work?
Pemetrexed is an antifolate drug that acts by restricting the cancer cells that alter the making and repairing of the DNA, thereby restricting the growth and multiplication of the cancer cells.
What Are the Uses of Pemetrexed?
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Pemetrexed is used to treat pleural mesothelioma (cancer affecting the outer covering of the lungs) and non-small cell carcinoma (non-squamous). It can be used either as a single agent or in combination with other anticancer agents like Cisplatin to treat other specific metastatic (cancer that has spread to different body parts) cancer.
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Pemetrexed comes in IV (intravenous) injection solution form and is given into a vein for over 10 minutes. It is given by the doctor, nurse, or healthcare professional once after every 21 days.
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Pemetrexed is given into the vein for over 10 minutes in the dose of 45 mL per minute for the management of non-squamous non-small cell lung carcinoma (NSCLC) after every 21 days cycle.
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Pemetrexed is given in combination therapy with Cisplatin in the dose of 45 mL per minute for over 10 minutes into the vein for the management of malignant pleural mesothelioma after each 21-day cycle.
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Patients are usually kept on Vitamin supplements like vitamin B12 injection or folic acid tablets before starting Pemetrexed and after the end of each cycle of 21 days.
Doses:
Pemetrexed comes in a liquid or solution form of 10 to 50 milliliters vials which are given into the vein by the doctor for over 10 minutes after every 21 days.
Warnings:
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Risk of Renal Impairment: Pemetrexed can cause renal failure or renal toxicity. Doctors usually check for renal clearance before starting the Pemetrexed medications before every dose. Dose modifications and adjustments are done based on renal clearance. If the renal clearance is more than 45 mg/mL dose adjustment is recommended.
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Risk of Myelosuppression: Patients who are not kept under vitamin supplements while on chemotherapy with Pemetrexed are at greater risk of myelosuppression. According to the clinical trials, patients who are on Pemetrexed in combination with Cisplatin for the treatment of cancer without any vitamin supplements present with neutropenia or thrombocytopenia. So, it is advised to keep the patients on vitamin supplements before starting Pemetrexed medications.
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Risk of Interstitial Pneumonitis: There is a risk of interstitial pneumonitis in patients undergoing chemotherapy sessions with Pemetrexed medications. It is advised to stop the drug Pemetrexed in case any symptoms like cough, fever, and dyspnea are observed, indicating pneumonitis.
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Risk of Fetal Toxicity: Pemetrexed, when administered in pregnant females, can result in the risk of toxicity to the fetus, according to clinical trials. It is advised to explain the risks before starting treatment with Pemetrexed.
For Patients:
What Conditions Can Be Treated by Chemotherapy With Pemetrexed?
Chemotherapy using a Pemetrexed drug is used to treat non-squamous cell lung carcinoma (NSCLC) and pleural mesothelioma, which is the involvement of the outer lining of the lungs by cancer cells. It is also used in the treatment of other different metastatic cancers (spread to different body parts) by using alone or in combination with other anticancer agents like Cisplatin.
Learn More About Pemetrexed:
When and Why to Take Pemetrexed?
Pemetrexed is an anticancer drug that is prescribed by the doctor to patients having metastatic non-squamous non-small cell lung cancer and pleural mesothelioma. Pemetrexed medications come in the dose of 10 to 50 milliliters vial solutions which are given intravenously (into the vein) by the healthcare professionals depending on the patient's condition.
For Non-Squamous Non-small Cell Lung Cancer: For non-squamous, non-small cell lung cancer Pemetrexed is given in a dose of 45 mL per minute for over 10 minutes after each 21 days cycle.
For Mesothelioma: For mesothelioma cancer of the pleural lining, Pemetrexed is used in combination with Cisplatin for patients in whom surgical resection for cure cannot be performed. In patients with malignant mesothelioma, Pemetrexed is recommended in combination therapy with Cisplatin in the dose of 45 mL per minute for over 10 minutes intravenously (into the veins) after every 21 days cycle.
Things to Inform the Doctor Before Starting Pemetrexed:
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Inform the doctor in case of any kind of allergies to any medications or their components.
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Inform the doctor if any medications or vitamin supplements are already undergoing.
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In case of any systemic disease like diabetes, hypertension, kidney disorders, and skin disease, inform the doctor before the chemotherapy session.
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Inform the doctor of any history of radiotherapy present.
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Inform the doctor in case of pregnancy, planning pregnancy, or breastfeeding mothers.
Starting Pemetrexed:
How to Use Pemetrexed Medication?
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Pemetrexed is an anticancer medicine that is available in the form of liquid or solution of 10 to 50 mL vials. It is given intravenously in a dose of 45 mL per minute for about 10 min after each cycle of 21 days by the healthcare professionals only.
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Doctors usually prescribe Vitamin B12 or folic acid supplements along with chemotherapy with Pemetrexed to minimize the side effects of the drug. Vitamin supplements should be consumed in the specific dose and schedule as prescribed by the doctor.
Things to Do After Starting Pemetrexed Chemotherapy Medication:
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After chemotherapy with Pemtrexed is started, observe for any adverse effects noted and inform the doctor about it.
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Improvement in signs and symptoms should be recorded and informed to the doctor during the follow-up chemotherapy sessions.
What Are the Side Effects?
Common Side Effects Associated With Pemetrexed Are:
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Nausea.
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Diarrhea.
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Vomiting.
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Sudden weight loss.
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Lethargy.
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Joint pain.
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Insomnia (difficulty in falling asleep).
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Pain in the joints.
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Stomach upset.
Some Serious Side Effects Associated With Pemetrexed Drug Are:
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Peeling of skin.
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Blisters or eruptions on the skin.
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Ulcers in the mouth, lips, or tongue that are quite painful.
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Increased heart rate.
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Pain in the chest.
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Difficulty in breathing.
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Difficulty in swallowing.
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Speech difficulties.
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Sore throat or fever.
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Numbness or weakness in the upper or lower extremities.
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Burning sensation in the hands and feet.
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Decreased urinary frequency.
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Itching or scratching of the skin.
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Unusual bleeding.
There are various other side effects related to the drug Pemetrexed. If any side effects are observed, inform the doctor immediately.
Overdose:
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If any of the above side effects are noticed, it is advised to inform the doctor immediately. In case of increased heart rate or trouble breathing, inform the poison control helpline immediately.
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No specific drug has been yet discovered to treat Pemetrexed overdose, according to the clinical trials.
Dietary Alterations: There is no specific diet alteration needed while on the Pemetrexed drug.
What Should Be Done if the Chemotherapy Session Is Missed?
If the intravenous dose of Pemetrexed is missed, it is advised to inform the doctor soon and get your injection dose done by healthcare professionals.
Storage of Pemetrexed:
Pemetrexed injections should be stored at 25 degrees Celsius temperature. It does not have any effects from the light.
For Doctors:
Indications of Pemetrexed:
Pemetrexed medicine is an antineoplastic agent of choice used as a single agent therapy or in combination with other anticancer drugs like Cisplatin in the management of:
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Metastatic non-squamous non-small lung carcinoma is an initial therapy with Cisplatin followed by maintenance therapy in patients with the arrest of the disease after completing four cycles of initial treatment with platinum-based chemotherapy.
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Malignant pleural mesothelioma as a combination therapy with Cisplatin.
Pharmacodynamics:
The drug Pemetrexed works by arresting the growth of mesothelioma cell lines. It also shows synergistic effects when given in combination with Cisplatin.
Chemical Taxonomy:
Kingdom- Organic compounds.
Superclass- Organic acid and derivatives.
Class- Carboxylic acids and derivatives.
Direct Parent- Glutamic acid and derivatives.
Molecular Framework- Aromatic hetero-polycyclic compounds.
Ingredients:
Active Ingredient:
The only active ingredient is Pemetrexed.
Inactive Ingredient:
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Mannitol.
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Hydrochloric acid.
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Sodium hydroxide.
Absorption:
The peak plasma concentration of Pemetrexed increases with increasing the dose of the drug.
Distribution:
The steady-state volume of the drug Pemetrexed is around 16.1 liters.
Protein Binding:
Around 81 percent of Pemetrexed is bound to plasma proteins.
Metabolism:
It is not metabolized in the liver to an appreciable extent.
Elimination:
Around 70 to 90 percent of the drug is recovered unchanged within the first 24 hours of administration.
Half-Life:
The half-life elimination of Pemetrexed is around 3.5 hours in patients with normal kidney function.
Clearance:
The complete systemic clearance of the drug Pemetrexed is around 91.8 mL per minute.
Doses and Forms:
The drug Pemetrexed is given in the dose of 10 to 50 mL vial solutions.
For injections, white to yellow or green-yellow lyophilized powder form is available for single-dose vials reconstitution.
Administration of the Drug:
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The drug Pemetrexed is given intravenously by healthcare professionals in the dose of 45 mL per minute for over 10 minutes on every first day of 21 days of a cycle for the treatment of non-squamous non-small cell carcinoma. It is given in combination therapy with Cisplatin during initial treatment, followed by maintenance therapy after completing four cycles with platinum-based chemotherapy.
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The drug Pemetrexed is given intravenously along with a combination therapy of Cisplatin agent in the dose of 45 mL per minute for over 10 minutes for the treatment of mesothelioma.
Contraindications:
The drug Pemetrexed is not indicated in patients with severe hypersensitivity reactions.
Drug Interactions:
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The elimination or excretion rate of Pemetrexed is decreased when given in combination with Abacavir, Acemetacin, Acetaminophen, and Aceclofenac, resulting in an increased concentration of Pemetrexed in the plasma.
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The drug Pemetrexed increases the risk of bleeding when combined with Abciximab.
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When combined with the drug Acetazolamide, the therapeutic efficacy of Pemetrexed increases.
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When combined with the drug Abatacept, the metabolism of Pemetrexed is increased.
Other Specifications:
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Pemetrexed in Pregnant and Lactating Women: The safety and efficacy of the use of Pemetrexed in pregnant and lactating women are not yet established according to clinical trials. Pemetrexed carries a risk of fetal harm in pregnant and lactating women, according to the research trials. Therefore it should be avoided in pregnant and lactating women.
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Pemetrexed in Pediatric populations: The safety of the drug Pemetrexed for pediatric use is yet not discovered. From the clinical trials, it was observed that the drug Pemetrexed shows similar side effects in both adults and children.
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Pemetrexed in Geriatric populations: The side effects of the drug Pemetrexed in the geriatric population were similar to those of the younger patients. However, there was a risk of anemia, hypertension, thrombocytopenia, and fatigue observed in Geriatric patients as compared to the younger patients according to the clinical trials.
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Pemetrexed in Patients with Renal Impairment: The drug Pemetrexed is eliminated primarily through the kidneys, so it should be avoided in patients with creatinine clearance of less than 45 mL per minute as it can result in higher exposure to the drug. It should be used only in patients with normal kidney functions.
What Are the Clinical Trials Ongoing for Pemetrexed?
Various clinical trials done for Pemetrexed are:
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Pemetrexed in Combination with Cisplatin: Pemetrexed is used in combination with Cisplatin for the treatment of non-small cell lung cell carcinoma.
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Malignant Pleural Mesothelioma: Pemetrexed disodium is used in combination with Cisplatin for the treatment of malignant pleural mesothelioma, according to clinical trials.
