Drug Action
Pemetrexed inhibits thymidylate transferase and other folate-dependent enzymes.
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Drug reference
Pemetrexed inhibits thymidylate transferase and other folate-dependent enzymes.
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Treatment of unresectable malignant pleural mesothelioma which has not previously been treated with chemotherapy (in combination with cisplatin) | First-line treatment of locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology (in combination with cisplatin) | Second-line treatment of locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology (monotherapy) | Maintenance treatment in locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology that has not progressed immediately following platinum-based chemotherapy (monotherapy) ▶BY INTRAVENOUS INFUSION ▶Adult: (consult local protocol)
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Diabetes. history of cardiovascular disease. prophylactic folic acid supplementation required (consult product literature). prophylactic vitamin B12 supplementation required (consult product literature)
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NICE decisions ▶Pemetrexed for the treatment of non-small cell lung cancer (August 2007) NICE TA124 Pemetrexed is not recommended for the treatment of locally advanced or metastatic non-small cell lung cancer which has previously been treated with chemotherapy. www.nice.org.uk/guidance/ta124 ▶Pemetrexed for the first-line treatment of non-small cell lung cancer (September 2009) NICE TA181 Pemetrexed, in combination with cisplatin, is an option for the first-line treatment of locally advanced or metastatic non-small cell lung cancer only if the histology of the tumour has been confirmed as adenocarcinoma or large- cell carcinoma. www.nice.org.uk/guidance/ta181 ▶Pemetrexed maintenance treatment for non-squamous non- small cell lung cancer after pemetrexed and cisplatin (August 2016) NICE TA402 Pemetrexed (Alimta ®) is recommended as an option for the maintenance treatment of locally advanced or metastatic non-squamous non-small cell lung cancer in patients when: . their disease has not progressed immediately after 4 cycles of pemetrexed and cisplatin induction therapy . their Eastern Cooperative Oncology Group performance status is 0 or 1 at the start of maintenance treatment, and, . the manufacturer provides the drug according to the terms of the commercial access agreement as agreed with NHS England. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, without change to their funding arrangements, until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta402 ▶Pemetrexed for the maintenance treatment of non-small-cell lung cancer (updated August 2017) NICE TA190 Pemetrexed (Alimta ®) is recommended as an option for the maintenance treatment of locally advanced or Immune system and malignant disease metastatic non-small cell lung cancer other than predominantly squamous cell histology if disease has not progressed immediately following platinum-based chemotherapy in combination with gemcitabine, paclitaxel or docetaxel. www.nice.org.uk/guidance/ta190 ▶Pemetrexed for the treatment of malignant pleural mesothelioma (January 2008) NICE TA135 Pemetrexed is an option for the treatment of malignant pleural mesothelioma only in patients who have a WHO performance status of 0 or 1 [WHO performance status is a measure of the ability to perform ordinary tasks], who are considered to have advanced disease and for whom surgical resection is considered inappropriate. www.nice.org.uk/guidance/ta135 Scottish Medicines Consortium (SMC) decisions SMC No. 342/07 The Scottish Medicines Consortium has advised (September 2008) that pemetrexed (Alimta ®) is accepted for restricted use within NHS Scotland as monotherapy for the second- line treatment of locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology. It is restricted for use in patients with good performance status who would otherwise be eligible for docetaxel treatment. SMC No. 531/09 The Scottish Medicines Consortium has advised (February 2010) that pemetrexed (Alimta ®) is accepted for restricted use within NHS Scotland in combination with cisplatin for the first-line treatment of locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology. It is restricted to patients in whom histology has been confirmed as adenocarcinoma or large cell carcinoma. SMC No. 770/12 The Scottish Medicines Consortium has advised (December 2014) that pemetrexed (Alimta ®) is accepted for use within NHS Scotland as monotherapy for the maintenance treatment of locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology in patients whose disease has not progressed immediately following platinum-based chemotherapy.
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→Appendix 1: pemetrexed
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▶Common or very common Appetite decreased. fatigue. mucositis. nausea. neuropathy sensory. oedema. pain. renal disorder. skin reactions. stomatitis. vomiting
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Manufacturer advises effective contraception during treatment. Men must avoid fathering a child during and for 6 months after treatment.
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Avoid (toxicity in animal studies). See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Discontinue breast-feeding.
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Manufacturer advises avoid if creatinine clearance less than 45 mL/minute—no information available.
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There can be variation in the licensing of different medicines containing the same drug. Powder for solution for infusion ELECTROLYTES: May contain Sodium ▶Pemetrexed (Non-proprietary) Pemetrexed (as Pemetrexed disodium) 100 mg Pemetrexed 100mg powder for concentrate for solution for infusion vials | 1 vial P £150.00–£185.22 (Hospital only) Pemetrexed (as Pemetrexed disodium) 500 mg Pemetrexed 500mg powder for concentrate for solution for infusion vials | 1 vial P £450.00–£926.10 (Hospital only) ▶Alimta (Eli Lilly and Company Ltd) Pemetrexed (as Pemetrexed disodium) 100 mg Alimta 100mg powder for concentrate for solution for infusion vials | 1 vial P £160.00 (Hospital only) Pemetrexed (as Pemetrexed disodium) 500 mg Alimta 500mg powder for concentrate for solution for infusion vials | 1 vial P £800.00 (Hospital only)
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(consult local protocol)
First-line fragment. Read the complete Indications and Dose section above.
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