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Treatment Name: Carboplatin + Pemetrexed (Alimta®) (Carbo/Pem)

Carboplatin + Pemetrexed (Alimta®) (Carbo/Pem) is a Chemotherapy Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)

How does Carboplatin + Pemetrexed (Alimta) chemotherapy work?
Each of the medications in the carboplatin pemetrexed (carbo/pem) chemotherapy regimen are designed to slow the growth of and kill cancer cells by altering (changing) cancer cell DNA.

Goals of therapy:
If there is no metastatic disease (lung cancer is limited to lung only and not other parts of body), carboplatin + pemetrexed is commonly given with the goal of cure. If metastatic disease is present (cancer has spread to other areas of the body), carboplatin + pemetrexed is not commonly given with the goal of cure, but rather to shrink tumors and decrease symptoms from lung cancer.

Schedule

Carboplatin/Pemetrexed Schedule

  • Carboplatin intravenous (I.V.) infusion administered over 30 minutes on Day 1
  • Pemetrexed I.V. infusion administered over 10 minutes on Day 1

Estimated total infusion time for this treatment:

  • Up to two hours for Day 1 of each cycle
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and I.V. fluids, such as hydration, may add more time

Carboplatin + pemetrexed is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, carboplatin + pemetrexed may be given in the hospital if someone is too sick.

Carboplatin + pemetrexed is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated up to 6 times. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.

Click here for common carboplatin/pemetrexed starting doses.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported carboplatin + pemetrexed side effects are shown here:

On average, 1 - 13% of patients discontinue carboplatin + pemetrexed due to unacceptable side effects.

Note: when hair loss occured, patients kept most of their hair, and hair loss was not obvious from a distance. Using a different hair style to cover the hair loss may make it less noticable.

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingBleedingBleedingFatigue Fatigue AnemiaAnemiaHair LossHair LossDiarrheaDiarrheaNeutropenic FeverNeutropenic FeverConstipationConstipationBlood ClotsBlood Clots

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment, at the completion of treatment, or during treatment at your doctor’s discretion. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue carboplatin + pemetrexed as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.

ChemoExperts Tips

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®) can affect your body’s ability to get rid of pemetrexed. Avoid NSAIDs starting 2 to 5 days prior to therapy and for at least two days after receiving pemetrexed
  • An intramuscular (I.M.) injection of vitamin B12 is recommended beginning one week prior to the first dose of pemetrexed to avoid possible toxicity. Injections are often given every 9 weeks (or 3 cycles) until therapy is complete
  • Starting one week prior to your first dose of pemetrexed, folic acid should be taken by mouth every day to avoid possible toxicity. Folic acid should be taken daily until 21 days after the last dose of pemetrexed
  • Remember to take the dexamethasone tablets twice daily for three days prior to treatment with pemetrexed. This drug helps prevent skin reactions. If you forget, be sure to alert the doctor, nurse, or pharmacist at the infusion center. An intravenous dose of dexamethasone may be given if you forget a dose(s) at home. On occasion, your doctor may decide to give intravenous dexamethasone at the infusion center instead of oral dexamethasone at home
  • Carboplatin hypersensitivity reaction can be severe. This reaction is most common after 6 to 9 cycles of carboplatin, but can happen after any dose. Some infusion centers may use "desensitization protocols" to allow a person to keep receiving carboplatin after they have had a reaction. Desensitization is used if someone is receiving a good response from carboplatin, or if few other chemotherapy options are available
  • Patients and their caregivers should be counseled to recognize the signs and symptoms of delayed drug reactions and report them immediately
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for lung cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Carboplatin + Pemetrexed (Alimta®) (Carbo/Pem), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Carboplatin + Pemetrexed (Alimta®) (Carbo/Pem). Depending upon your income, they may be able to help cover the cost of:

  • Carboplatin
  • Pemetrexed

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Carboplatin + Pemetrexed (Alimta®) (Carbo/Pem) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Carboplatin + Pemetrexed (Alimta®) (Carbo/Pem)

Individual Drug Label Information

Carboplatin (Paraplatin®)

  • Carboplatin is an intravenous infusion 
  • This medication is dosed based on your kidney function. If your kidney function improves or worsens during therapy, your dose may need to be adjusted
  • This drug should not be used during pregnancy, it may cause fetal harm
General Carboplatin (Paraplatin) Side Effects:  
  • Low red blood cells, low white blood cells, and most commonly, low platelets can be occur
  • Nausea and vomiting is common but can be prevented by taking certain pre-medications
  • Hair loss
  • Constipation and/or diarrhea
  • Pain
  • Allergic reactions to carboplatin can occur. These typically are not seen until after the 6th dose of carboplatin is given 
  • Can cause liver damage at high doses 
  • May cause kidney damage or hearing loss if combined with other medications that also cause these side effects 
  • Click on the carboplatin (Paraplatin) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossBleedingBleedingConstipationConstipationPainPainAnemiaAnemia

See DailyMed package insert.

Pemetrexed (Alimta®)

  • Pemetrexed is an intravenous infusion 
  • Dosage adjustments may be required for severe toxicity 
  • Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided starting 2 to 5 days prior to therapy and for at least 2 days after receiving pemetrexed 
  • Intramuscular (I.M.) injection of vitamin B12 and oral folic acid are given throughout treatment to decrease the risk of experiencing side effects from pemetrexed. These are started 7 days prior to the first dose of pemetrexed 
  • Skin reactions can be common. Oral dexamethasone should be taken twice daily for 3 days prior to treatment to decrease the severity of skin reactions. As an alternative, intravenous dexamethasone may be given on the day of treatment instead 
  • Avoid during pregnancy. Contact your doctor immediately if you think you may have become pregnant. Females who are of child bearing age should use contraception during treatment 
General Pemetrexed (Alimta) Side Effects 
  • May cause low red blood cells, white bloods cells, and platelets 
  • Severe liver toxicity can occur in patients with decreased liver function 
  • Can cause various gastrointestinal symptoms such as nausea, vomiting, diarrhea, or decreased appetite 
  • Fatigue and weakness 
  • Constipation 
  • Although rare, serious allergic reactions have been reported 
  • May cause mouth sores 
  • Click on the pemetrexed (Alimta) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue ConstipationConstipationAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1) Scagliotti GV, Kortsik C, Dark GG. Pemetrexed combined with oxaliplatin or carboplatin as first-line treatment in advanced non–small cell lung cancer: a multicenter, randomized, phase II trial. Clin Cancer Res 2005;11:690-696.

2) Zhang L, Ou W, Liu Q. Pemetrexed plus carboplatin as adjuvant chemotherapy in patients with curative resected non-squamous non-small cell lung cancer. Thoracic Cancer 2014;5:50–56.

Created: September 19, 2016 Updated: October 5, 2018

What is Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)?

What is Non-Small Cell Lung Cancer?
A disease of the tissue found in the lung.  Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Known causes include smoking and exposure to environmental toxins.  The stage of NSCLC can vary at diagnosis and throughout treatment.  Stages include stage I, II, III, and IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does "Cure" mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Common Carboplatin/Pemetrexed starting doses

  • Carboplatin AUC = 5 or 6 as an intravenous (I.V.) over 30 minutes on Day 1
  • Pemetrexed 500 mg/m2 I.V. over 10 minutes on Day 1

AUC = Area under the curve

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1) Scagliotti GV, Kortsik C, Dark GG. Pemetrexed combined with oxaliplatin or carboplatin as first-line treatment in advanced non–small cell lung cancer: a multicenter, randomized, phase II trial. Clin Cancer Res 2005;11:690-696.

2) Zhang L, Ou W, Liu Q. Pemetrexed plus carboplatin as adjuvant chemotherapy in patients with curative resected non-squamous non-small cell lung cancer. Thoracic Cancer 2014;5:50–56.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium