Pemetrexed for the maintenance treatment of non-small-cell lung cancer

Pemetrexed disodium (Alimta, Eli Lilly and Company) is an antifolate agent that works by disrupting folate-dependent metabolic processes that are essential for cancer cell replication and survival. Pemetrexed has a marketing authorisation for the maintenance treatment of locally advanced or metastatic non-small-cell lung cancer other than predominantly squamous cell histology in patients whose disease has not progressed immediately following platinum-based chemotherapy. The marketing authorisation states that first-line treatment should be a platinum doublet with gemcitabine, paclitaxel or docetaxel. (A platinum doublet is platinum-based chemotherapy plus one other drug).

The summary of product characteristics (SPC) states that the recommended dosage is 500 mg per m² body surface area, administered as a 10-minute intravenous infusion on the first day of each 21-day cycle. To reduce toxicity, patients treated with pemetrexed should also receive folic acid and vitamin B12 supplements. To reduce the incidence and severity of skin reactions, premedication with a corticosteroid is recommended.

The SPC reports that the most common adverse effects include nausea, vomiting, fatigue, leukopenia (particularly of the neutrophil component), skin rash, mucositis and liver function abnormalities. For full details of side effects and contraindications, see the SPC.

The acquisition cost of pemetrexed is £800 for a 500-mg vial (excluding VAT, BNF 57th edition). The cost per patient, assuming an average of 8 cycles and a body surface area of 1.79 m², is approximately £12,076. Costs may vary in different settings because of negotiated procurement discounts.