Pemetrexed

DEA Class; Rx

Common Brand Names; Alimta, Pemfexy

Pyrimidine-based antifolate that targets multiple enzymes, including thymidine synthase, dihydrofolate reductase, and glycinamide ribonucleotide formyltransferase
Used for the treatment of NSCLC and mesothelioma
Requires supplementation with folic acid and vitamin B12 to mitigate hematologic and GI toxicities, and dexamethasone for cutaneous toxicities

History of severe hypersensitivity reaction to pemetrexed

• Nausea (31-82%)
• Vomiting (16-57%)
• Neutropenia (11-56%)
• Fatigue (34-48%)
• Anemia (19-26%)
• Thrombocytopenia (8-23%)
• Stomatitis/pharyngitis (15-23%)
• Anorexia (20-22%)
• Diarrhea (13-17%)
• Rash (14-16%)
• Decreased CrCl (16%)
• Constipation (6-12%)
• Alopecia (11%)
• Elevated creatinine (11%)
• Neutropenia (5-23%)
• Nausea (12%)
• Vomiting (2-11%)

Treatment can cause severe, and sometimes fatal, renal toxicity; determine creatinine clearance before each dose and periodically monitor renal function during treatment with drug; withhold therapy in patients with a creatinine clearance of <45 mL/minute

Serious and sometimes fatal, bullous, blistering and exfoliative skin toxicity, including cases suggestive of Stevens-Johnson Syndrome/Toxic epidermal necrolysis can occur; permanently discontinue drug for severe and life-threatening bullous, blistering or exfoliating skin toxicity

Serious interstitial pneumonitis, including fatal cases, can occur with treatment; withhold drug for acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, or fever pending diagnostic evaluation; if pneumonitis is confirmed, permanently discontinue therapy

Radiation recall can occur in patients who have received radiation weeks to years previously; monitor patients for inflammation or blistering in areas of previous radiation treatment; permanently discontinue therapy for signs of radiation recall

Based on findings from animal studies and its mechanism of action, therapy can cause fetal harm when administered to a pregnant woman; avoid pregnancy (see Pregnancy)

Based on animal data, pemetrexed can cause malformations and developmental delays when administered to a pregnant woman

There is no information regarding presence of drug or its metabolites in human milk, effects on breastfed infant, or on milk production

500 mg/m2 IV infusion every 21 days.

500 mg/m2 IV infusion every 21 days.

Safety and efficacy have not been established.

Safety and efficacy have not been established.