Pemetrex-Venus

Pemetrexed

In combination w/ cisplatin for chemotherapy-naive patients w/ unresectable malignant pleural mesothelioma; for 1st line treatment of patients w/ locally advanced or metastatic NSCLC other than predominantly squamous cell histology. Monotherapy for the maintenance treatment of locally advanced or metastatic NSCLC other than predominantly squamous cell histology in patients whose disease has not progressed immediately following platinum-based chemotherapy; for 2nd line treatment of patients w/ locally advanced or metastatic NSCLC other than predominantly squamous cell histology.

In combination w/ cisplatin 500 mg/m² via IV infusion over 10 min on Day 1 of each 21-day cycle + cisplatin 75 mg/m² infused over 2 hr approx 30 min thereafter. NSCLC 500 mg/m² via IV infusion over 10 min on Day 1 of each 21-day cycle. Premed regimen Administer corticosteroid prior to, on the day of, & the day after pemetrexed administration. Corticosteroid equiv to 4 mg oral dexamethasone bid. Should also receive vit supplementation: Oral folic acid or multivit containing folic acid (350-1,000 mcg) daily; take at least 5 doses during 7 days prior to 1st dose of pemetrexed, & continue during the full course of therapy & for 21 days after the last dose of pemetrexed. May also receive IM vit B₁₂ (1,000 mcg) in the wk preceding the 1st dose of pemetrexed & once every 3 cycles thereafter; subsequent doses may be given on the same day as pemetrexed.

Hypersensitivity. Concomitant use w/ yellow fever vaccine.

Monitor patients for myelosuppression during therapy & do not give in patients until ANC returns to ≥1,500 cells/mm³ & platelet count returns to ≥100,000 cells/mm³. Should take folic acid & vit B₁₂ as prophylactic measure. Pre-treatment w/ dexamethasone (or equiv). Consider drainage of 3rd-space fluid collection prior to treatment. Adequate anti-emetic treatment & appropriate hydration prior to &/or after receiving treatment. Preexisting CV risk factors. Patients treated w/ radiation either prior, during, or subsequent to therapy. Caution in use of radiosensitising agents. Not recommended for patients w/ CrCl <45 mL/min. Patients w/ mild & moderate renal insufficiency (CrCl 45-79 mL/min) should avoid taking NSAIDs eg, ibuprofen & aspirin (>1.3 g daily) for 2 days before, on the day, & 2 days following pemetrexed administration. Serious renal events, including acute renal failure. Concomitant use w/ live attenuated vaccines is not recommended. Men are advised not to father a child during treatment & up to 6 mth thereafter. Women of childbearing potential must use effective contraception during treatment. Caution against driving or operating machines if fatigue occurs. Pregnancy & lactation (discontinue during therapy).

Decreased neutrophils/granulocytes, leucocytes, Hb, platelets, CrCl; nausea, vomiting, stomatitis/pharyngitis, anorexia, diarrhoea (also w/o colostomy), constipation; fatigue; neuropathy-sensory; elevated creatinine, SGPT, SGOT; rash/desquamation, alopecia. Conjunctivitis; dyspepsia; dehydration; taste disturbance; fever; pruritus; pain. MI, angina pectoris, CVA, transient ischaemic attack.

Potential delay in clearance w/ nephrotoxic drugs eg, aminoglycosides, loop diuretics, platinum compd, cyclosporin; substances that are tubularly secreted eg, probenecid, penicillin. May decrease elimination w/ high-doses of NSAIDs eg, ibuprofen (>1,600 mg/day) & aspirin (≥1.3 g/day). Potential interaction w/ NSAIDs having longer t_½ eg, piroxicam & rofecoxib. Increased thrombotic risk w/ anticoagulants. Risk of fatal generalised vaccinale disease w/ yellow fever vaccine. Risk of systemic, possibly 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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