Initial treatment of patients w/ locally advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC) & malignant pleural mesothelioma whose disease is unresectable or who are otherwise not candidates for curative surgery in combination w/ cisplatin. Maintenance treatment of locally advanced or metastatic NSCLC whose disease has not progressed after 4 cycles of platinum-based 1st-line chemotherapy. As single agent for locally advanced or metastatic NSCLC after prior chemotherapy.
Combination w/ cisplatin for nonsquamous NSCLC or malignant pleural mesothelioma 500 mg/m2 as IV infusion over 10 min on day 1 of each 21-day cycle or 75 mg/m2 infused over 2 hr beginning approx 30 min after the end of pemetrexed admin. Single-agent as maintenance following 1st-line or 2nd-line therapy 500 mg/m2 as IV infusion over 10 min on day 1 of each 21-day cycle. Premed regimen & concurrent medications Vit supplementation: Initiate folic acid 400-1,000 mcg orally once daily beginning 7 days before 1st dose of pemetrexed, continue during the full course of therapy & for 21 days after the last dose of pemetrexed. Administer vit B12 1 mg IM 1 wk prior to the 1st dose of pemetrexed & every 3 cycles thereafter. Subsequent vit B12 inj may be given the same day as treatment w/ pemetrexed. Corticosteroids: Administer dexamethasone 4 mg by PO bid before, the day of, & the day after pemetrexed admin.
Initiate supplementation w/ oral folic acid & IM vit B12 prior to treatment to reduce the severity of hematologic & GI toxicity. Bone marrow suppression. Concomitant admin of NSAIDs. Do not initiate treatment unless ANC is ≥1,500 cells/mm3, platelet count is ≥100,000 cells/mm3 & CrCl ≥45 mL/min. Renal & hepatic impairment. Pregnancy & lactation. Childn. Elderly.
Sign Out
