II. Indications
- FDA Approved (in combination regimens)
- Mesothelioma (malignant, pleural)
- Non-Small Cell Lung Cancer (non-squamous cell)
- Off-Label Use
- Bladder Cancer (metastatic)
- Cervical Cancer
- Ovarian Cancer (resistant)
- Thymic Cancer
III. Contraindications
- Children
- Creatinine Clearance <45 ml/min
IV. Mechanism
- Pemetrexed is a synthetic Pyrimidine-based antifolate agent, similar to Methotrexate
- Pemetrexed binds the enzyme thymidylate synthase (TS), blocking its activity
- Inhibits methylation of dUMP to dTMP
- Inhibits DNA synthesis
V. Medications
- Pemetrexed powder for IV Solution: Available in 100 mg and 500 mg vials
VI. Dosing
- See other references for disease specific dosing protocols
- Coadministered agents to reduce adverse effects
- Folic Acid 400 to 1000 mcg orally daily for 21 days (after last dose)
- Vitamin B12 1000 mcg IM every 3 Pemetrexed cycles
- Dexamethasone 4 mg orally twice daily for 3 days starting on the day prior to treatment
VII. Adverse Effects
- Myelosuppression
- Rash
- Decreased with Dexamethasone (see dosing above)
VIII. Safety
- Avoid in Pregnancy (any trimester)
- Use reliable Contraception
- Avoid in Lactation
- Monitoring
IX. Drug Interactions
-
NSAIDs
- Avoid coadministering at time of Pemetrexed infusion
X. Resources
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | A synthetic pyrimidine-based antifolate. Pemetrexed binds to and inhibits the enzyme thymidylate synthase (TS), which catalyses the methylation of 2'-deoxyuridine-5'-monophosphate (dUMP) to 2'-deoxythymidine-5'-monophosphate (dTMP), an essential precursor in DNA synthesis. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C085586 |
SnomedCT | 409159000, 411089001 |
English | L-Glutamic acid, N-(4-(2-(2-amino-4,7-dihydro-4-oxo-1H-pyrrolo(2,3-d)pyrimidin-5-yl)ethyl)benzoyl)-, N-(4-(2-(2-amino-3,4-dihydro-4-oxo-7H-pyrrolo(2,3-d)pyrimdin-5-yl)ethyl)benzoyl)glutamic acid, N-[4-[2-(2-Amino-4,7-dihydro-4-oxo-1H-pyrrolo[2,3-d]pyrimidin-5-yl)ethyl]benzoyl]-L-glutamic Acid Disodium Salt, Multitargeted Antifolate, L-Glutamic Acid, N-(4-(2-(2-Amino-4,7-dihydro-4-oxo-1H-pyrrolo(2,3-d)pyrimidin-5-yl)ethyl)benzoyl), pemetrexed (medication), pemetrexed [Chemical/Ingredient], mta, MTA, PEMEtrexed, pemetrexed, Pemetrexed, Pemetrexed (product), Pemetrexed (substance), PEMETREXED |
Spanish | pemetrexed (producto), pemetrexed (sustancia), pemetrexed |