Pemetrexed and cisplatin | Cancer Research UK
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What pemetrexed and cisplatin is

Pemetrexed and cisplatin is a combination of chemotherapy drugs used to treat non small cell lung cancer and a cancer of the outer covering of the lungs called mesothelioma.

  • Pemetrexed is also called Alimta
  • Cisplatin is sometimes just called plat or platinum

How this treatment works

The chemotherapy drugs in the pemetrexed and cisplatin combination destroy quickly dividing cells such as cancer cells. 


How you have pemetrexed and cisplatin

You have the drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.

You can read our information about having cancer drugs.

You have both drugs by drip over about 8 hours once every 3 weeks. You may have 4 to 6 treatments, taking 3 to 6 months in total.

Medicines to reduce side effects

While having pemetrexed and cisplatin you need to

  • Take folic acid tablets – starting 5 days before you begin treatment, continuing throughout treatment, and for 3 weeks after treatment ends
  • Have vitamin B12 injections – 1 injection in the week before you start treatment and then 1 before every 3rd treatment cycle (every 9 weeks)

You also take steroid tablets. You start these the day before you have your chemotherapy. You take them twice a day for 3 days – with breakfast and with lunch.

It is very important to take tablets according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer medicine without talking to your specialist first.


Tests during treatment

You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.


About side effects

We've listed the side effects associated with pemetrexed and cisplatin. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.

You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)

The side effects may be different if you are having pemetrexed and cisplatin with other medicines.

Tell your doctor, nurse or pharmacist straight away if any of the side effects get severe.


Common side effects

More than 10 in every 100 people have one or more of these effects.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
  • Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Feeling or being sick – this is usually well controlled with anti sickness medicines
  • Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
  • Ringing in the ears (tinnitus) happens in about 3 in 10 people (30%) but nearly always gets better on its own
  • A sore mouth
  • Kidney damage – you will have blood tests before your treatment to make sure your kidneys are able to cope with the drugs
  • Women may stop having periods (amenorrhoea) but this may be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these effects.

  • Some people have an allergic reaction while having this treatment, usually at the 1st or 2nd treatment. Tell your treatment team straight away if you feel hot or have any skin rashes or itching. Also tell them if you have dizziness, headaches, shivering, breathlessness, anxiety, flushing of the face, or a sudden need to pass urine
  • Hair thinning
  • A skin rash – you may have some itching and your skin may become sore
  • Loss of appetite
  • Loss of taste or a metallic taste
  • A high temperature (fever) – taking paracetamol every 6 to 8 hours can help until your temperature goes down
  • Liver changes that are very mild and unlikely to cause symptoms – these will almost certainly go back to normal when treatment ends
  • Loss of ability to hear some high pitched sounds, which usually gets better on its own
  • Numbness or tingling in fingers and toes affects about 4 out of every 100 people (4%). It can cause difficulty with fiddly things such as doing up buttons. This starts within a few days or weeks and usually goes within a few months of finishing treatment

Rare side effects

Fewer than 1 in 100 people have damage to heart muscle, which is usually temporary but for a small number of people may be permanent. Your doctor will check your heart before and after your treatment.


Important points to remember

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. Your nurse will give you a number to call if you are worried.

Other medicines

Tell your doctor, nurse or pharmacist about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Don't breastfeed during this treatment because the drug may come through in the breast milk.


Immunisations and chemotherapy

You shouldn't have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


Related information


More information about these drugs

This page doesn't list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 17 December 2015