• Malignant pleural mesothelioma as initial therapy when tumor is unresectable or patient is not a candidate for surgery (in combination with cisplatin).
• Metastatic non-squamous non–small-cell lung cancer (NSCLC) as initial therapy in patients without epidermal growth factor receptor or anaplastic lymphoma kinase genomic tumor aberrations (in combination with platinum-based therapy and pembrolizumab).
• Locally advanced or metastatic non-squamous NSCLC as initial therapy (in combination with cisplatin).
• Locally advanced or metastatic non-squamous NSCLC as maintenance treatment in patients whose disease has not progressed after 4 cycles of platinum-based first-line chemotherapy (as monotherapy).
• Recurrent, metastatic non-squamous NSCLC after previous chemotherapy (as monotherapy).

Contraindicated in:

• Hypersensitivity
• CCr <45 mL/min
• OB: Pregnancy
• Lactation: Lactation.

Use Cautiously in:

• Concurrent use of NSAIDs in patients with CCr 45–79 mL/min (avoid those with short half-lives)
• Third space fluid accumulation (ascites, pleural effusions); consider drainage prior to therapy
• Hepatic impairment (dose alteration recommended)
• Women of reproductive potential and men with female partners of reproductive potential
• Pedi: Safety and effectiveness not established in children.

CV: chest pain.

Derm: desquamation, rash, radiation recall, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS.

GI: constipation, nausea, stomatitis, vomiting, anorexia, diarrhea, esophagitis, mouth pain.

GU: ↓fertility (men).

Hemat: anemia, hemolytic anemia, leukopenia, thrombocytopenia.

Neuro: neuropathy.

Resp: pharyngitis, INTERSTITIAL PNEUMONITIS.
Misc: fever, infection.

Drug-Drug:

• NSAIDs, especially those with short half-lives, ↑ levels and risk of toxicity; avoid for 2 days before, day of, and 2 days after treatment. Probenecid↑ levels.
• Concurrent use of nephrotoxic agents↑ risk of nephrotoxicity.

(Generic available)

• Lyophilized powder for injection: 100 mg/vial; 500 mg/vial; 1 g/vial;
• Solution for injection: 10 mg/mL; 25 mg/mL;

Non-Squamous Non–Small-Cell Lung Cancer

• IV (Adults): Initial therapy (with cisplatin): 500 mg/m² on Day 1 of each 21-day cycle for up to 6 cycles (administer before cisplatin); Initial therapy (with platinum-based therapy and pembrolizumab): 500 mg/m² on Day 1 of each 21-day cycle for 4 cycles (administer before carboplatin or cisplatin and after pembrolizumab). Following completion of platinum-based therapy, pemetrexed may be administered as monotherapy or with pembrolizumab as maintenance therapy until disease progression or unacceptable toxicity; Maintenance treatment (as monotherapy) or disease recurrence (as monotherapy): 500 mg/m² on Day 1 of each 21-day cycle until disease progression or unacceptable toxicity.

Mesothelioma

• IV (Adults): 500 mg/m² on Day 1 of each 21-day cycle until disease progression or unacceptable toxicity.

Alimta, Pemfexy

• Disrupts folate dependent metabolic processes involved in thymidine and purine synthesis. Converted intracellularly to polyglutamate form which increases duration of action.

• Decreases growth and spread of mesothelioma.
• Improved survival in patients with non-squamous NSCLC.

Therapeutic Classification: antineoplastics

Pharmacologic Classification: antimetabolites, folate antagonists

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Minimal metabolism; 70–90% excreted unchanged in urine.

Half-life: 3.5 hr (normal renal function).

(hematologic effects)

• Explain purpose of pemetrexed to patient.
• Emphasize the importance of taking prophylactic folic acid and vitamin B₁₂ to reduce treatment-related hematologic and GI toxicity.
• Advise patient to notify health care professional immediately if signs and symptoms of infection (fever, sore throat), anemia, or neurotoxicity occur.
• Instruct patients to notify health care professional if persistent vomiting, diarrhea, or signs of dehydration appear.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially NSAIDs, and to avoid alcohol during therapy.
• May cause fetal harm. Advise females of reproductive potential to use effective contraception during and for at least 6 mo after last dose of pemetrexed and to avoid breastfeeding during and for at least 1 wk after last dose. Advise males with female partners of reproductive potential to use effective contraception during and for at least 3 mo after last dose. If pregnancy is planned or suspected, notify health care professional promptly. May impair fertility in males.

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