Pemetrexed is a chemotherapy drug used to treat non-small cell lung cancer and pleural mesothelioma (a type of cancer that affects the lining of the lungs). Pemetrexed can be given alongside other chemotherapy medications.
BEFORE HAVING PEMETREXED
You will be given folic acid and vitamin B12 before your pemetrexed treatment begins and throughout the chemotherapy. It is very important that you take these, as they reduce the side effects of pemetrexed without hindering its effectiveness.
You can take folic acid in tablets. You usually take it for the five days before the first treatment and then each day until three weeks have passed since the pemetrexed treatment has finished.
While taking pemetrexed, it is best not to take any folic acid supplements other than those prescribed by your cancer specialist. Some multivitamins or food supplements contain folic acid, which is why you should talk to your pharmacist before taking them.
Vitamin B12 is injected into a muscle one week before the first treatment with pemetrexed and again every third treatment (about every nine weeks).
You will need to take steroid tablets every three days beginning the day before you have pemetrexed. These help prevent skin reactions.
Always take the tablets exactly as you are instructed.
HOW IS PEMETREXED ADMINISTERED?
Pemetrexed is given in the chemotherapy day unit or during a hospital stay. A chemotherapy nurse will give it to you.
Before the day of treatment, a nurse will take a blood sample from you to see if you are fit for chemotherapy.
You will also be able to see a doctor or nurse before having chemotherapy. They will ask you how you have been feeling. If the results of your blood test are good on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will give you medication for nausea and, sometimes, steroids administered intravenously. Chemotherapy drugs may be given in the following ways:
- Through a thin tube (line) inserted into a vein in the arm or hand by a nurse
- Through a tube that goes below the skin of your chest to a nearby vein (central line)
- Through a thin tube that is placed in a vein of the arm and goes up through a vein toward the chest (PICC)
Your nurse will give you pemetrexed as a drip (perfusion) through a cannula or a line for about 10 minutes. This kind of drip is usually given using a perfusion pump for the sake of timing.
THE CHEMOTHERAPY CYCLE
You will have chemotherapy as part of a course or cycle, consisting of several treatment sessions and lasting several months. Each cycle of pemetrexed normally lasts for 3 weeks. Once the 21 days are up, you will start your second cycle of pemetrexed. This is the same as the first cycle.
But this will depend on the type of cancer you have. Your doctor or nurse will tell you more about this and how many cycles you are going to have.
POSSIBLE SIDE EFFECTS OF PEMETREXED
You may experience some of the side effects mentioned here, though it is rare for a patient to have all of them. If you receive other chemotherapy drugs, you may have other side effects that are not mentioned here. Always inform your doctor of the effects you experience.
Your doctor can prescribe medication to help control some of the side effects. It is very important to take the medication exactly as your doctor says for it to have the highest chance of working well. Your nurse will advise you on managing the side effects. After treatment, the side effects start to get better.
RISK OF INFECTION
Pemetrexed may lower the number of white blood cells in your blood. This will make you more susceptible to infection. Your nurse can tell you when you might have the lowest levels of these cells. When the number of white blood cells is low, this is called neutropenia.
Contact your hospital immediately if any of the following happens:
- your temperature goes above 38 ° C
- you suddenly feel unwell, even if your temperature is normal.
- You have symptoms of infection, which may include sore throat, coughing, or the need to urinate frequently.
The number of white blood cells normally increases gradually, returning to normal before your next chemotherapy session. You will have a blood test before your next chemotherapy. If your white blood cells are still low, your doctor may postpone the treatment for a short period of time.
BRUISING AND BLEEDING
Pemetrexed may lower the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any unexplained bleeding or bruising. This includes nosebleeds, bleeding gums, blood spots, or skin eruptions (rashes). Some people may require additional platelets.
Pemetrexed may lower the number of red blood cells in your blood. Red blood cells transport oxygen throughout the body. If you have a low number of red blood cells, you may be tired and short of breath. Tell your doctor or nurse if you feel like this. If you are very anemic, it's possible you will require a blood transfusion.
This can happen on the first few days after chemotherapy. Your doctor will prescribe you antiemetic drugs to help prevent or control your nausea. It is easier to prevent nausea than it is to treat it once it has begun.
If you still have nausea or are vomiting, get in touch with the hospital as soon as possible. They can give you advice and change your medication to one that works better.
LOSS OF APPETITE
You may lose your appetite during the treatment. Try to eat in small quantities and have frequent meals. Don't worry if you don't eat much for a day or two. If your appetite doesn't get any better after a few days, tell your nurse or dietitian. They can give you nutritional supplements or good-tasting meal-replacement drinks.
SORENESS OF THE MOUTH
You may have a sore mouth or mouth ulcers, which could make you more prone to getting a mouth infection. Lightly brush your teeth and/or dentures in the morning and night and after meals. Use a soft-bristle toothbrush. Your nurse might ask you to rinse your mouth out regularly or use mouthwash. It is important that you follow all the instructions you are given and that you drink a lot of fluids.
Tell your nurse or doctor if you have any mouth problems. They can prescribe you drugs to prevent or treat infections of the mouth and to treat any kind of pain.
Your doctor can prescribe medicines to control diarrhea. Let them know if your diarrhea is severe or if it doesn't get better. Make sure you drink at least two liters of fluids each day if you have diarrhea.
Feeling very tired is a common side effect. Fatigue is often worst toward the end of treatment and for a few months after the treatment has finished. Try to pace yourself and rest as much as you need to. Help balance this with a bit of light exercise, such as short walks. If you feel drowsy, don't drive or operate heavy machinery.
Chemotherapy can affect your skin. Pemetrexed can produce a rash, which may cause itchiness. If your skin is dry, try to use a fragrance-free moisturizing cream every day. Always tell your doctor about any change to your skin. These changes can be temporary, improving once the treatment is over.
NUMBNESS OR TINGLING IN THE HANDS OR FEET
These symptoms are caused by the effect of pemetrexed on the nerves. It is called peripheral neuropathy. It may also be hard for you to press buttons and it can make other tasks more uncomfortable.
Always tell your doctor if you have these symptoms. They may be able to control the symptoms by lowering the drug dose you are given. The symptoms normally get better slowly once the treatment is over, though in some people they may never go away.
LESS COMMON SIDE EFFECTS OF PEMETREXED
You may have pain in your eyes or they may become swollen (conjunctivitis). Your doctor can prescribe eye drops if you need them.
Your hair may thin out, though it is unlikely you will lose all of the hair on your head. Hair loss normally starts after your first or second cycle of chemotherapy. It is almost always temporary, and the hair will continue to grow after you finish your chemotherapy. Your nurse can give you advice on how to cope with losing your hair.
Pemetrexed can cause constipation. Drinking at least two liters of fluids each day will help if this is the case. Try to eat more high-fiber foods such as fruit, vegetables, and whole-grain bread and get some light exercise.
CHANGES IN THE KIDNEYS AND LIVER
Pemetrexed can affect the way the kidneys and liver function. These changes are normally mild and return to normal after the treatment. You will have blood tests done before the chemotherapy to see how your kidneys and liver are functioning.
It is important for you to tell your doctor or nurse immediately if you feel ill or develop severe side effects. This includes any that are not mentioned here.
MORE INFORMATION ABOUT PEMETREXED
BLOOD CLOT RISK
Cancer and chemotherapy increase the chances of a blood (thrombosis). The symptoms include pain, reddening or swelling in a leg, difficulty breathing, and pain in the chest. Get in touch with your doctor immediately if you have any of these symptoms.
Some medicines can interact with chemotherapy or be harmful if they are taken alongside chemotherapy. This includes medications that can be purchased in a store or pharmacy. Tell your doctor the medicines you are taking, including over-the-counter medications, complementary therapies, and herbal medicines.
Pemetrexed may affect your fertility. If this worries you, you can talk to your doctor before beginning treatment.
Your doctor will advise you not to become pregnant during the treatment. This is because the drugs can harm developing babies. It is important to use contraception during chemotherapy and for a few months after the treatment ends.
If you have sex within the first few days after chemotherapy, it is necessary to use a condom. This is to protect your partner in case there is chemotherapy in semen or vaginal fluid.
Women are recommended not to breastfeed during treatment and for a few months after chemotherapy has concluded. This is in case the chemotherapy enters their breast milk.
MEDICAL AND DENTAL TREATMENT
If you have to go to the hospital for whatever reason other than cancer, always tell the doctors and nurses that you are having chemotherapy.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always let your dentist know that you are having chemotherapy.