Alimta

Pemetrexed disodium

In combination w/ cisplatin for chemotherapy-naive patients w/ unresectable malignant pleural mesothelioma. Monotherapy as 2nd-line treatment or in combination w/ cisplatin as 1st-line treatment of patients w/ locally advanced or metastatic NSCLC other than predominantly squamous cell histology. Monotherapy for maintenance of locally advanced or metastatic NSCLC other than predominantly squamous cell histology in patients whose disease has not progressed immediately following platinum-based chemotherapy. In combination w/ pembrolizumab & platinum chemotherapy for 1st-line treatment of patients w/ metastatic non-squamous NSCLC w/ no EGFR or ALK genomic tumor aberrations.

500 mg/m² by IV infusion over 10 min on 1st day of each 21-day cycle. In combination w/ cisplatin Cisplatin 75 mg/m² infused over 2 hr approx 30 min after pemetrexed infusion. Premed Dexamethasone 4 mg or equiv PO bd the day prior to, on the day & day after pemetrexed administration. Patient must take oral folic acid or multivit containing folic acid 350-1,000 mcg daily for at least 5 doses during the 7 days preceding 1st dose of pemetrexed. Continue dosing during the full course of therapy & for 21 days after last dose of pemetrexed. Patient must also receive vit B₁₂ 1,000 mcg IM inj in the wk preceding 1st dose of pemetrexed & once every 3 cycles thereafter. Subsequent vit B₁₂ inj may be given on the same day as pemetrexed.

Hypersensitivity. Concomitant use w/ yellow fever vaccine. Lactation.

Discontinue use in haematologic or non-haematologic Grade 3 or 4 toxicity. Not to be given to patients until ANC returns to ≥1500 cells/mm³ & platelet count returns to ≥100,000 cells/mm³. Monitor for myelosuppression, acute tubular necrosis, decreased renal function, signs & symptoms of nephrogenic diabetes insipidus eg, hypernatraemia. Pre-existing CV risk factors. Premed w/ folic acid & vit B₁₂ as prophylaxis against treatment-related toxicity & dexamethasone to reduce incidence & severity of skin reactions. Monitor CBC including differential white cell & platelet counts prior to each dose. Ensure adequate antiemetic treatment & appropriate hydration prior to &/or after therapy. Not recommended in immunodepressed status & concomitant use w/ live attenuated vaccines. Concomitant use w/ other radiosensitising agents. May affect ability to drive & use machines. Avoid NSAIDs, ASA in mild to moderate renal impairment (CrCl 45-79 mL/min). Not recommended in patients w/ CrCl <45 mL/min. May affect fertility. Males should not father a child during & up to 3 mth after treatment. Women of childbearing potential should use effective contraception during & for 6 mth after treatment. Not to be used during pregnancy & lactation.

Infection, pharyngitis; neutropenia, leukopenia, decreased Hb; stomatitis, anorexia, vomiting, diarrhoea, nausea; rash, skin exfoliation; decreased CrCl, increased blood creatinine; fatigue. Sepsis; febrile neutropenia, decreased platelet count; hypersensitivity; dehydration; taste disorder, peripheral motor & sensory neuropathy, dizziness; conjunctivitis, dry eye, increased lacrimation, keratoconjunctivitis sicca, eyelid oedema, ocular surface disease; cardiac failure, arrhythmia; dyspepsia, constipation, abdominal pain; increased ALT & AST; hyperpigmentation, pruritus, erythema multiforme, alopecia, urticaria; renal failure, decreased GFR; pyrexia, pain, oedema, chest pain, mucosal inflammation; increased γ-glutamyltransferase.

Delayed clearance w/ nephrotoxic drugs (eg, aminoglycoside, loop diuretics, platinum compd, cyclosporin), probenecid, penicillin. Decreased elimination w/ high-dose NSAIDs, ASA. Monitor INR w/ oral anticoagulants. Fatal generalised vaccinale disease w/ yellow fever vaccine. Increased risk of fatal disease w/ live attenuated vaccines.

Cytotoxic Chemotherapy

L01BA04 - pemetrexed ; Belongs to the class of antimetabolites, folic acid analogues. Used in the treatment of cancer.

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