Pemetrexed Brand Name– Alimta
What is Pemetrexed
Pemetrexed is a pyrimidine-based antifolate that suppresses tumor growth by inhibiting both DNA synthesis and folate metabolism at multiple target enzymes, including thymidine synthetase (TS), dihydrofolate reductase (DHFR), and glycinamide ribonucleotide formyltransferase (GARFT).
The multiple enzyme inhibition is unique, as methotrexate inhibits only dihydrofolate reductase, and 5-fluorouracil and raltitrexed inhibit only thymidine synthetase.
Thus, pemetrexed may be useful for 5-fluorouracil-, methotrexate-, and raltitrexed-resistant cancers.
Folic acid and vitamin B12 supplementation is needed to reduce hematologic and gastrointestinal toxicity and enable therapy continuation; dexamethasone is also required to mitigate cutaneous toxicity.
Pemetrexed is FDA approved alone, in combination with cisplatin, and in combination with carboplatin and pembrolizuamb for the treatment of non-small cell lung cancer (NSCLC), and in combination with cisplatin for mesothelioma.
It may also be used to treat head and neck cancer, bladder cancer, breast cancer, and gastric cancer.
Indications
- bladder cancer
- breast cancer
- gastric cancer
- head and neck cancer
- mesothelioma
- non-small cell lung cancer (NSCLC)
- pancreatic cancer
For the treatment of malignant pleural mesothelioma
for the treatment of unresectable malignant pleural mesothelioma, in combination with cisplatin
Side Effects
- abdominal pain
- alopecia
- alopecia
- anaphylactoid reactions
- anemia
- anemia
- anorexia
- anorexia
- arrhythmia exacerbation
- asthenia
- bullous rash
- chest pain (unspecified)
- colitis
- conjunctivitis
- constipation
- cough
- dehydration
- dehydration
- depression
- diarrhea
- diarrhea
- dysgeusia
- dyspepsia
- dyspepsia
- dyspnea
- dyspnea
- edema
- elevated hepatic enzymes
- elevated hepatic enzymes
- erythema multiforme
- esophagitis
- fatigue
- fatigue
- fever
- GI obstruction
- hemolytic anemia
- hyperglycemia
- hyperglycemia
- hyperkalemia
- hyperkalemia
- hypertension
- hypoalbuminemia
- hypoalbuminemia
- hypocalcemia
- hypocalcemia
- hypokalemia
- hypokalemia
- hyponatremia
- hyponatremia
- hypophosphatemia
- hypophosphatemia
- infection
- infection
- lacrimation
- lymphopenia
- nausea
- nausea
- neutropenia
- neutropenia
- pancreatitis
- peripheral neuropathy
- peripheral neuropathy
- pharyngitis
- pharyngitis
- pneumonitis
- pruritus
- pulmonary embolism
- pyrosis (heartburn)
- pyrosis (heartburn)
- radiation recall reaction
- rash
- rash
- renal failure (unspecified)
- Stevens-Johnson syndrome
- stomatitis
- stomatitis
- syncope
- thrombocytopenia
- thrombocytopenia
- thromboembolism
- thrombosis
- toxic epidermal necrolysis
- urticaria
- ventricular tachycardia
- vomiting
- vomiting
Monitoring Parameters
- CBC with differential
- serum creatinine/BUN
Contraindications
- bone marrow suppression
- breast-feeding
- children
- contraception requirements
- geriatric
- infants
- infertility
- neonates
- neutropenia
- pneumonitis
- pregnancy
- pulmonary disease
- radiation therapy
- renal impairment
- reproductive risk
- thrombocytopenia
- vaccination
Interactions
- Abciximab
- Alpha interferons
- Alteplase
- Anagrelide
- Anticoagulants
- Antithrombin III
- Antithymocyte Globulin
- Apixaban
- Argatroban
- Aspirin, ASA; Dipyridamole
- Bacillus Calmette-Guerin Vaccine, BCG
- Betrixaban
- Bivalirudin
- Carbamazepine
- Cilostazol
- Clopidogrel
- Dabigatran
- Dalteparin
- Danaparoid
- Desirudin
- Diphenhydramine; Ibuprofen
- Dipyridamole
- Echinacea
- Edoxaban
- Enoxaparin
- Eptifibatide
- Famotidine; Ibuprofen
- Febuxostat
- Fondaparinux
- Glucarpidase
- Heparin
- Hydrocodone; Ibuprofen
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Influenza Virus Vaccine
- Intranasal Influenza Vaccine
- Lepirudin
- Live Vaccines
- Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
- Measles/Mumps/Rubella Vaccines, MMR
- Palifermin
- Penicillamine
- Pentosan
- Platelet Inhibitors
- Prasugrel
- Reteplase, r-PA
- Rivaroxaban
- Rotavirus Vaccine
- Rubella Virus Vaccine Live
- Sapropterin
- Smallpox and Monkeypox Vaccine, Live, Nonreplicating
- Smallpox Vaccine, Vaccinia Vaccine
- Streptokinase
- Tenecteplase
- Thrombolytic Agents
- Ticagrelor
- Ticlopidine
- Tinzaparin
- Tirofiban
- Tuberculin Purified Protein Derivative, PPD
- Typhoid Vaccine
- Urokinase
- Varicella-Zoster Virus Vaccine, Live
- Vorapaxar
- Warfarin
- Yellow Fever Vaccine, Live
