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Pemetrexed Dosage

Medically reviewed on August 22, 2018.

Applies to the following strengths: 500 mg; 100 mg

Usual Adult Dose for Malignant Pleural Mesothelioma

COMBINATION USE WITH CISPLATIN in patients with a CrCl of 45 mL/min or greater: 500 mg/m2 as IV over 10 minutes on Day 1 of each 21-day cycle until disease progression or unacceptable toxicity

PREMEDICATION REGIMEN AND CONCURRENT MEDICATIONS:
-Vitamin Supplementation: Patients should initiate folic acid 400 to 1000 mcg orally once daily beginning 7 days before the first dose of chemotherapy. Folic acid should be continued during the full course of therapy and for 21 days after the last dose.
-Vitamin B12 1 mg should be administered IM 1 week prior to the first dose of chemotherapy and every 3 cycles thereafter.
-Subsequent vitamin B12 injections may be given the same day as therapy.
-Corticosteroids: Dexamethasone 4 mg orally 2 times a day the day before, the day of, and the day after chemotherapy administration.

Comments:
-See the cisplatin manufacturer package insert for more information.

Use: In combination with cisplatin for the treatment of patients with malignant pleural mesothelioma whose disease is unresectable or who are otherwise not candidates for curative surgery

Usual Adult Dose for Non-Small Cell Lung Cancer

COMBINATION USE WITH CISPLATIN for initial treatment of nonsquamous non-small cell lung cancer in patients with a CrCl of 45 mL/min or greater: 500 mg/m2 IV over 10 minutes administered prior to cisplatin on Day 1 of each 21-day cycle for up to 6 cycles in the absence of disease progression or unacceptable toxicity

FOR MAINTENANCE TREATMENT of NSCLC in patients with a CrCl of 45 mL/min or greater: 500 mg/m2 as IV over 10 minutes on Day 1 of each 21-day cycle until disease progression or unacceptable toxicity after 4 cycles of platinum-based first-line chemotherapy

FOR TREATMENT OF RECURRENT NSCLC in patients with a CrCl of 45 mL/min or greater: 500 mg/m2 IV over 10 minutes on Day 1 of each 21-day cycle until disease progression or unacceptable toxicity

COMBINATION USE CARBOPLATIN AND PEMBROLIZUMAB for the initial treatment of NSCLC in patients with a CrCl of 45 mL/min or greater: 500 mg/m2 IV over 10 minutes on Day 1 of each 21-day cycle until disease progression or unacceptable toxicity after 4 cycles. Following completion of platinum-based therapy, this drug may be administered as maintenance therapy, alone or with pembrolizumab, until disease progression or unacceptable toxicity. Pembrolizumab should be administered prior to this drug when given on the same day. Please refer to the full prescribing information for pembrolizumab and for carboplatin.

PREMEDICATION REGIMEN AND CONCURRENT MEDICATIONS:
-Vitamin Supplementation: Patients should initiate folic acid 400 to 1000 mcg orally once daily beginning 7 days before the first dose of chemotherapy. Folic acid should be continued during the full course of therapy and for 21 days after the last dose.
-Vitamin B12 1 mg should be administered IM 1 week prior to the first dose of chemotherapy and every 3 cycles thereafter.
-Subsequent vitamin B12 injections may be given the same day as therapy.
-Corticosteroids: Dexamethasone 4 mg orally 2 times a day the day before, the day of, and the day after chemotherapy administration.

Comments:
-See the cisplatin manufacturer package insert for more information.

Uses:
-in combination with cisplatin for the initial treatment of patients with locally advanced or metastatic, non-squamous, non-small cell lung cancer (NSCLC)
-In combination with carboplatin and pembrolizumab for the initial treatment of patients with metastatic, non-squamous NSCLC.
-As a single agent for the maintenance treatment of patients with locally advanced or metastatic, non-squamous NSCLC whose disease has not progressed after 4 cycles of platinum-based first-line chemotherapy
-As a single agent for the treatment of patients with recurrent, metastatic non-squamous, NSCLC after prior chemotherapy

Renal Dose Adjustments

CrCl 45 mL/min or greater: No adjustment recommended.
CrCl less than 45 mL/min: Use is not recommended.

Liver Dose Adjustments

Data not available

Dose Adjustments

MYELOSUPPRESSIVE TOXICITY:
-ANC less than 500/mm3 AND platelets greater than or equal to 50,000/mm3 OR platelet count less than 50,000/mm3 without bleeding: Use 75% of the previous dose.
-Platelet count less than 50,000/mm3 with bleeding: Use 50% of the previous dose.
-Recurrent Grade 3 or 4 myelosuppression after 2 dose reductions: Discontinue therapy.

NONHEMATOLOGIC TOXICITIES (excluding mucositis or neurotoxicity) Grade 3 or 4 OR diarrhea requiring hospitalization: Use 75% of the previous dose.

GRADE 3 OR 4 MUCOSITIS: Use 50% of the previous dose.

GRADE 3 OR 4 NEUROLOGIC TOXICITY: Permanently discontinue therapy.

RECURRENT GRADE 3 OR 4 NON-HEMATOLOGIC TOXICITY AFTER 2 DOSE REDUCTIONS: Permanently discontinue therapy.

SEVERE AND LIFE-THREATENING SKIN TOXICITY: Permanently discontinue therapy.

INTERSTITIAL PNEUMONITIS: Permanently discontinue therapy.

Precautions

CONTRAINDICATIONS:
-Hypersensitivity to the active component or any of the ingredients

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-This drug should be administered under the supervision of a qualified physician experienced in the use of antineoplastic agents. Appropriate management of complications is possible only when adequate diagnostic and treatment facilities are readily available.

Storage requirements:
-Refer to the manufacturer product information.

Reconstitution/preparation techniques:
-Refer to the manufacturer product information.

IV compatibility:
-This drug is incompatible with calcium containing solutions such as lactated Ringers injection and Ringers injection.

General:
-This drug is not indicated for the treatment of patients with squamous cell non-small cell lung cancer.

Monitoring:
-Complete blood cell counts, including platelet counts, should be performed on all patients receiving this drug.
-Patients should be monitored for nadir and recovery, which were tested in the clinical study before each dose and on days 8 and 15 of each cycle. Patients should not begin a new cycle of treatment unless the ANC is 1500 cells/mm3 or greater, the platelet count is 100,000 cells/mm3 or greater, and CrCl is 45 mL/min or greater.
-Periodic chemistry tests should be performed to evaluate renal and hepatic function.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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