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Treatment Name: Cisplatin + Pemetrexed (Alimta®)

Cisplatin + Pemetrexed (Alimta®) is a Chemotherapy Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)

How does cisplatin + pemetrexed work?
Each of the medications in cisplatin + pemetrexed are designed to slow the growth of and kill cancer cells.

Goals of therapy:
Cisplatin + pemetrexed is given to shrink tumors and decrease symptoms of lung cancer. Cisplatin + pemetrexed can be given either after surgery to eliminate microscopic cells, or cisplatin + pemetrexed can be given before surgery to shrink the size of the tumor and minimize the size of the surgery.

If there is no metastatic disease (lung cancer is limited to lung only and not other parts of body), cisplatin + pemetrexed is commonly given with the goal of cure.  

If metastatic disease is present (cancer has spread to other areas of the body), cisplatin + pemetrexed is not commonly given with the goal of cure, but rather to shrink tumors and decrease symptoms from lung cancer.

Schedule

  • Cisplatin intravenous (I.V.) infusion over 1 hour on Day 1
  • Pemetrexed I.V. infusion over 10 minutes on Day 1

Estimated total infusion time for this treatment:

  • Up to 3.5 hours for each cycle. Intravenous hydration is often given both before and after cisplatin
  • 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

Click here for common starting doses

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

Cisplatin + pemetrexed is repeated every 21 days. This is known as one cycle. Each cycle may be repeated up to 4 to 6 times, depending upon the stage of the disease. Duration of therapy may last up to 5 to 6 months, depending upon response, tolerability, and number of cycles prescribed.

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 side effects with cisplatin + pemetrexed are shown here. Side effects sometimes have percentage ranges [example 9 – 15%] because they differed between clinical studies. In these studies, only the number of patients experiencing severe or very severe side effects was reported. Therefore, percentages for milder symptoms may be higher:

Roughly 7% of patients discontinue cisplatin + pemetrexed due to unacceptable side effects.

Side effect videos Side Effect Videos
Hair LossHair LossNausea and VomitingNausea and VomitingFatigue Fatigue AnemiaAnemiaConstipationConstipationBlood ClotsBlood ClotsPainPainNeutropenic FeverNeutropenic Fever

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each treatment and may be checked periodically in between cycles. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood magnesium levels, 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 cisplatin + pemetrexed as planned, or delay or switch 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 2 days after receiving pemetrexed
  • An intramuscular (I.M.) injection of vitamin B12 is recommended begining 1 week prior to the first dose of pemetrexed to avoid possible toxicity. Injections are often given every 9 weeks until therapy is complete
  • Starting 1 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 3 day 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
  • Cisplatin can possibly damage the kidneys. Be sure to maintain good hydration to lessen the risk of experiencing kidney damage from cisplatin
  • 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 Cisplatin + Pemetrexed (Alimta®), 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 Cisplatin + Pemetrexed (Alimta®). Depending upon your income, they may be able to help cover the cost of:

  • Cisplatin
  • 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 Cisplatin + Pemetrexed (Alimta®) 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 Cisplatin + Pemetrexed (Alimta®)

Individual Drug Label Information

Cisplatin (Platinol®)

  • Cisplatin is an intravenous (I.V.) infusion that is typically given over one to two hours
  • Cumulative toxicity to kidneys from cisplatin can be severe 
  • Other toxicities from multiple doses are:  low blood counts, nausea, vomiting, and hearing loss
  • Dosage adjustments may be required for poor kidney function or bone marrow toxicity (low blood counts) 
  • Cisplatin is hazardous to a human fetus; women should avoid pregnancy while on this drug 
  • Women should not breast-feed while on cisplatin; it has been reported to be in human milk 
  • Patients on anticonvulsant drugs may have decreased levels while on cisplatin 
General Cisplatin (Platinol) Side Effects 
  • Kidney problems (nephrotoxicity), especially in elderly patients. 
  • Nausea and vomiting, both acute (within first 24 hours) and delayed (two to five days after infusion) 
  • Diarrhea 
  • Low blood cell counts (myelotoxicity, acute leukemia)
  • Hearing problems- ringing ears.  All patients should have a baseline hearing test done.  All children should have hearing test done before each dose and for several years after therapy is complete 
  • Low blood electrolytes:  magnesium, potassium, calcium, sodium, and phosphate
  • Nerve pain 
  • Vision problems; improvement and/or complete recovery usually occurs after stopping therapy 
  • Liver toxicity; recovery usually occurs after stopping therapy 
  • Click on the cisplatin (Platinol) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

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, Parikh P, von Pawel J, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008;26:3543-3551.

2. Kreuter M, Vansteenkiste J, Fischer JR, et al. Randomized phase 2 trial on refinement of early-stage NSCLC adjuvant chemotherapy with cisplatin and pemetrexed versus cisplatin and vinorelbine: the TREAT study. Ann Oncol. 2013;24:986-992.

Created: February 19, 2016 Updated: August 30, 2016

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.

Common Starting Doses

  • Cisplatin 75 mg/m2 I.V. infusion over 1 hour on Day 1
  • Pemetrexed 500 mg/m2 I.V. infusion over 10 minutes on Day 1

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability

Clinical Studies

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

1. Scagliotti GV, Parikh P, von Pawel J, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008;26:3543-3551.

2. Kreuter M, Vansteenkiste J, Fischer JR, et al. Randomized phase 2 trial on refinement of early-stage NSCLC adjuvant chemotherapy with cisplatin and pemetrexed versus cisplatin and vinorelbine: the TREAT study. Ann Oncol. 2013;24:986-992.

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

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.