OncoLink en espanõl
Treatment Options > Chemotherapy > OncoLink Rx
Pemetrexed
Ryan P. Smith, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: February 15, 2004
Other Name: Alimta (ah-LIM-tah, Eli Lilly and Company)
| What It Is Used For: | ALIMTA, when given with another drug called cisplatin, has been approved by the Food and Drug Administration (FDA) for the treatment of patients with malignant pleural mesothelioma (MPM) when surgery is not an option. |
| How it works: | Alimta works by blocking three separate enzymes that cells need to replicate. These enzymes, needed for folate-dependent metabolic processes, are required for DNA replication. Therefore, inhibiting these enzymes inhibits cellular growth. |
| How it is given: | Alimta is administered intravenously, via a single 10 minute infusion every three weeks. Patients usually receive it as an outpatient, and it may be delivered with other chemotherapeutic drugs. Steroid medication is often administered for two days prior to receiving Alimta to decrease skin rash. Folic acid supplementation should precede the administration of Alimta by a week and should continue throughout the treatment course and for three weeks afterwards. An intramuscular injection of vitamin B12 should precede the first administration of Alimta and should be administered with every subsequent dose. These vitamin supplementations decrease many of the side effects of Alimta. |
Side Effects and Precautions
Let your doctor or nurse know if you have any allergies and what medications you are currently taking, both prescription and over the counter medications. This includes vitamins, herbs, nutritional supplements and any recreational drugs. Not everyone experiences side effects and most side effects are temporary. The side effects that you may experience are:
Common Side Effects
Hematologic Side effects (decreasing of blood counts)
This is the most common side effect of Alimta, though severe effects are still only seen in less than 25% of patients.
Decreasing the number of white blood cells. This includes decrease in a specific kind of white blood cell, called neutrophils, causing neutropenia. This puts you at risk for infection.
What to do: Call your doctor or nurse for a fever of 100.4F or greater. Avoid people with the flu or colds. When working in your yard, wear protective clothing including long pants and gloves. Do not handle pet waste. Keep all cuts and scratches clean. Shower or bath daily and refer to Chemotherapy and You (NCI, 1997) for mouth care. Do not cut cuticles or ingrown nails. You may wear nail polish but not fake nails. Ask your doctor or nurse before scheduling dental appointments or procedures. Ask your doctor or nurse before you or a family member has any vaccinations. If your white blood cell count becomes dangerously low, your physician may start you on a medication to increase your count.
Decrease in red blood cells (anemia)
Anemia causes fatigue and a general loss of energy.
What to do: Call your doctor or nurse if you feel more tired than usual or short of breath while doing normal activities. If anemia becomes severe, you may require a transfusion or a medication to increase your red blood cell count.
Decrease in platelets (thrombocytopenia)
This puts you at risk for bruising and bleeding.
What to do: Call your doctor or nurse if you notice any unusual bruising or bleeding. Do not floss or use toothpicks. Use a soft-bristle toothbrush or cotton swab. Ask your doctor or nurse before scheduling dental appointments or procedures. Use an electric razor to avoid cuts. Do not use medication containing aspirin or ibuprofen without asking your doctor or nurse.
Skin rash
This consists of a red, sometimes itchy rash, with or without flaking of the skin.
What to do: Call your doctor or nurse if you develop a rash, itchy skin or blistering of the skin. Keep the areas clean. Your doctor may prescribe creams, ointments and pain medications if needed.
Stomatitis/Pharyngitis
This is the formation of ulcers within the mouth or throat, or less severely, irritation of the lining of the mouth and throat.
What to do: Call your doctor or nurse if your mouth, tongue or inside of your cheek becomes white, ulcerated or painful. Brush with a soft-bristle toothbrush or cotton swab twice a day. Avoid mouthwashes that contain alcohol. A baking soda and/or salt warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon salt in an eight ounce glass of warm water) is recommended 4 times daily. If your mouth becomes dry, eat moist foods, drink plenty of fluids (6-8 glasses) and suck on sugarless hard candy. Avoid drinking alcoholic beverages and citrus juices, smoking and chewing tobacco.
Gastrointestinal side effects
A majority of patients have actually reported some mild nausea and vomiting. However, only approximately 10% had severe nausea and vomiting. In addition, approximately 25% had mild diarrhea, though very few had severe diarrhea.
What to do: Obviously nausea/vomiting and diarrhea is uncomfortable. However, the larger concern with these symptoms is the development of dehydration. To attempt to avoid this, take your anti-nausea or anti-diarrheal medications as prescribed. Try to drink 6-8 glasses of fluids a day. Avoid eating fatty foods, large meals, acidic foods (e.g. tomatoes, lemons, oranges, grapefruits) and spicy or hot foods when you feel nauseated. Call your doctor or nurse if you are Unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time, as this could indicate dehydration.
Fatigue
Fatigue is often multifactorial, with anemia often playing a role in the development of fatigue. Approximately one out of five patients treated with Alimta complained of severe fatigue.
What to do: If severe fatigue develops, the most important thing to do is to ensure that there is not a serious underlying cause. This most commonly includes anemia, dehydration, malnutrition, or infection. These should all be investigated. In the meantime, common sense prevails, and activities should be curtailed somewhat so that you do not become exhausted or endanger yourself by performing strenuous activities.
Uncommon Side Effects
Uncommon side effects include shortness of breath, blood clots, and an allergic reaction to the medication. These were all experienced in less than 10% of patients.