Pemetrexed: Brands, Price & Uses in Bangladesh

Pemetrexed is a chemotherapy agent (antifolate) used, always under the supervision of a physician experienced in cancer chemotherapy, for the following FDA-approved and guideline-supported indications:

Non-Squamous Non-Small Cell Lung Cancer (NSCLC)

• First-line combination therapy (established): In combination with pembrolizumab and platinum chemotherapy, as initial treatment of metastatic non-squamous NSCLC in patients with no EGFR or ALK genomic tumor aberrations.
• First-line combination therapy (established): In combination with cisplatin, for initial treatment of locally advanced or metastatic non-squamous NSCLC.
• Maintenance therapy (established): As a single agent, for maintenance treatment of metastatic non-squamous NSCLC in patients whose disease has not progressed after four cycles of platinum-based first-line chemotherapy.
• Second-line/recurrent disease (established): As a single agent, for the treatment of recurrent metastatic non-squamous NSCLC after prior chemotherapy.

Pemetrexed is not indicated, and should not be used, for the treatment of squamous cell NSCLC (adjunct/combination use only in non-squamous histology).

Malignant Pleural Mesothelioma

• Combination therapy (established): In combination with cisplatin, for the treatment of patients with unresectable malignant pleural mesothelioma.

Pemetrexed is used only in combination regimens for first-line NSCLC and mesothelioma treatment, and as single-agent therapy only for maintenance or previously-treated recurrent non-squamous NSCLC, as outlined above. It is not appropriate for self-directed or non-oncology use.

Pemetrexed dosing is calculated by body surface area (BSA) and must be individualized and adjusted by the treating oncologist based on the specific regimen, prior toxicity, and laboratory results. It is given only as an intravenous infusion.

Mandatory Premedication

• Folic acid: 400–1000 micrograms orally once daily, starting approximately 7 days before the first dose and continued throughout treatment and for 21 days after the last dose.
• Vitamin B12: 1 mg intramuscularly, given approximately 1 week before the first dose and then every 3 cycles thereafter.
• Corticosteroid (e.g., dexamethasone): typically 4 mg orally twice daily for 3 consecutive days, starting the day before Pemetrexed administration, to reduce the incidence and severity of skin rash.

See Dosage, Administration, Use in Special Populations, and Precautions and Warnings sections for renal function requirements, dose modifications for toxicity, and pre-dose laboratory monitoring requirements. Pemetrexed must never be self-administered or given outside a supervised oncology infusion setting.

Pemetrexed commonly causes side effects related to its effect on rapidly dividing cells; severity and pattern vary by whether it is given alone or in combination with cisplatin or pembrolizumab-platinum regimens.

Very Common / Common

• Fatigue, decreased appetite (anorexia)
• Nausea, vomiting, constipation, diarrhea
• Stomatitis/mucositis, mouth sores
• Myelosuppression: neutropenia, anemia, thrombocytopenia (increasing risk of infection, bleeding, or need for transfusion)
• Elevated liver enzymes (transaminases)
• Rash or skin reactions (reduced by corticosteroid premedication)
• Alopecia (hair thinning/loss, less common than with many other chemotherapy agents)

Serious / Less Common

• Severe myelosuppression with febrile neutropenia or serious infection
• Renal impairment or acute kidney injury (see Precautions)
• Interstitial pneumonitis (lung inflammation) — may present as new or worsening cough, shortness of breath, or fever
• Severe bullous, blistering, or exfoliative skin reactions
• Radiation recall reaction in patients with prior radiotherapy
• Severe gastrointestinal toxicity (dehydration from vomiting/diarrhea)

Patients should promptly report fever, unusual bleeding or bruising, severe mouth sores, breathing difficulty, or severe skin reactions to their treating physician.