Pemetrexed is a drug that can be administered either as monotherapy or in combination with cisplatin or carboplatin. The route of administration is intravenous and the administration schedule is once day every 3 weeks.
Pemetrexed is used for the treatment of patients diagnosed with non-small cell non-squamous lung cancer (adenocarcinoma or large cell carcinoma). In fact, pemetrexed is not effective in patients diagnosed with squamous cell carcinoma expressing high levels of thymidylate synthase, an enzyme that interferes with the metabolism of pemetrexed, making it less effective. It is used as a first line treatment in combination with carboplatin or cisplatin or as a second line treatment alone (monotherapy).
The reactions to chemotherapy vary from individual to individual: some patients have very few side effects, others, instead, have to bear more serious consequences. The side effects described in the Pharmacological Profile will not necessarily affect all those who undergo treatment with pemetrexed. You should also keep in mind that the side effects may be different if the treatment is carried out in a combination of chemotherapy drugs rather than as a monotherapy.
During pemetrexed therapy, it is necessary to take Folingrav 1cp/day and an administration of Dobetin 1 vial im every 9 weeks to reduce side effects. Do not take NSAIDs (such as Aspirin, Nimesulide, Aulin, Ibuprofen) 3 days before and 3 days after chemotherapy.
The Pharmacological Profile takes into consideration the most common and also the least frequent side effects so that you are prepared if they occur. On the other hand, very rare side effects have been neglected. If you feel any effect that you think may be connected with taking the drug, but not mentioned in the Pharmacological Profile, talk about it with the oncologist who is treating you.
Potential side effects of Pemetrexed
Temporary reduction in the production of blood cells by the bone marrow. Pemetrexed can cause anemia, resulting in fatigue; tendency to develop bruising, or bleeding and an increased risk of developing infections. This effect can occur about seven days after drug administration and blood cell counts usually reach their lowest values 10-14 days after chemotherapy. Then it begins to gradually rise again and usually normalizes within 21-28 days.
If the temperature rises above 38°C or if you develop bruising or bleeding with no apparent reason, or if you suddenly do not feel well even if the temperature is normal, immediately contact the oncologist or hospital.
Nausea and vomiting. Today, we have very effective drugs, called anti-emetics, to prevent or significantly reduce nausea and vomiting. If nausea occurs anyway despite taking these medications, it may occur within a few hours after treatment and last for 24 hours. If the nausea is not controllable or persists, inform the oncologist, who will not hesitate to prescribe another more effective antiemetic.
Loss of appetite. The dietitian or a specialized nurse will be able to give you the right directions.
Fatigue and general widespread weakness.
Impairment of renal and hepatic function. During treatment with pemetrexed, blood samples should be taken regularly to assess kidney and liver function.
Less frequent side effects
Numbness or tingling in the hands and feet. This effect is determined by the action of the drug on the nerves, and it is called peripheral neuropathy. It occurs rarely if the treatment is carried out with a normal dosage. You may notice, for example, that you have difficulty buttoning clothes or performing other tasks that require manual skill. If you experience numbness or a tingling sensation in your hands or feet, inform the oncologist. The situation gradually improves within a few months after the end of the treatment.
Conjunctivitis. The use of artificial tears may be useful.
Diarrhea. It can usually be controlled with medication but inform the oncologist if it is severe or persistent. In case of diarrhea, you have to drink a lot to replenish lost fluids.
Tenderness of the oral cavity and alteration of taste. During treatment, you may experience a painful sensation in your mouth, which may be particularly dry, and you may notice small ulcers. To prevent this side effect, it is important to drink plenty of fluids and clean your teeth regularly with a soft toothbrush. If you have any of these problems, inform the oncologist, who will be able to prescribe special mouthwashes and medications to prevent or treat possible oral infections. Furthermore, you may notice that the food no longer tastes the same, but everything will return to normal after the treatment has ended.
Hair loss. This is a very rare side effect. If this occurs, it will usually begin to fall three to four weeks after the start of treatment, although it may happen sooner. In any case, it is a temporary effect and the hair will grow back once the treatment is complete.
Some medicines may interfere with chemotherapy. For this reason, consult the oncologist before taking other drugs.
Fertility: The drug can affect the ability to conceive. It is important that you deal with fertility problems with the oncologist before treatment begins.
Contraception: It is not advised to start a pregnancy or conceive a child if you are being treated with pemetrexed, as the drug could compromise fetal development. Effective contraception is required during drug administration and for a few months after treatment is completed. Again, discuss this openly with the oncologist.