Pemetrexed (Alimta)

Pemetrexed is a type of chemotherapy. You pronounce it as peh-meh-trek-sed. It is also known as Alimta.

It is a treatment for:

• pleural mesothelioma (cancer of the outer covering of the lungs)

• non small cell lung cancer (NSCLC)

You might have pemetrexed on its own or in combination with other cancer drugs. 

How does pemetrexed work?

Pemetrexed is a type of drug known as an anti metabolite. It stops cancer cells making and repairing DNA so they can't grow and multiply.

How do you have pemetrexed?

You have pemetrexed as a drip into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

How often do you have pemetrexed?

You have pemetrexed as cycles of treatment. This means you have the treatment and then a rest to allow your body to recover. Each cycle usually lasts 3 weeks.

How you have each cycle varies depending on if you have pemetrexed on its own or with another cancer drug. Your doctor, nurse or pharmacist will tell you more about this.

To help reduce the side effects of pemetrexed you might have the following medication. This depends on your circumstances. The following are examples, you might have:

• folic acid tablets starting at least 5 days before you begin treatment, continuing throughout treatment, and for 3 weeks after treatment ends

• vitamin B12 injections. You have one injection in the week before you start treatment and then one before every 3rd treatment cycle (every 9 weeks). You also have one a few weeks after your last pemetrexed treatment

You may also have a steroid tablet to help with the side effects, starting on the day before your chemotherapy. You take the tablets twice a day, for up to 3 days with breakfast and lunch. 

Your doctor, nurse or pharmacist will explain what you need to take and when to take them.

Tests

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

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV . This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system and can cause the virus to become active again (reactivation). 

You might also have a chest x-ray before and during your treatment.

What are the side effects of pemetrexed?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Mouth sores and ulcers

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Loss of appetite 

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Fatigue (tiredness)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Skin problems 

Skin problems include a skin rash, dry skin and itching. More rarely you might have darker patches or redness. This usually goes back to normal when your treatment finishes. Your healthcare team can tell you what products you can use on your skin to help.

To reduce the skin rash your nurse might give you corticosteroids. You usually take them on the day before treatment, the day of treatment, and the day afterwards.

Kidney changes

To help prevent kidney damage, it is important to drink plenty of water. You might also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.

Sore throat (pharyngitis) 

You might get a sore, scratchy, dry throat as the tissues can become inflamed. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include: 

• sepsis - a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, slurred speech or confusion, breathlessness, mottled or discoloured skin, extreme shivering or muscle pain. Call 999 or go to accident and emergency (A&E) immediately if you have any of these symptoms
• an allergic reaction that can cause a skin rash, burning or a prickling sensation
• bruising, nosebleeds or bleeding caused by a drop in platelets in your blood
• hair loss or hair thinning
• high temperature (fever)
• loss of fluid (dehydration) that can make you feel thirsty and have dark yellow and strong smelling urine
• pain in your chest and tummy (abdomen)
• inflammation of the eyes and watery eyes (conjunctivitis), dry eyes, swollen eyelids, excess tears
• taste changes that can make you go off certain foods
• indigestion symptoms including heartburn, bloating and burping
• opening your bowels less than normal or difficulty opening your bowels (constipation)
• liver changes that are usually mild and unlikely to cause symptoms
• numbness or tingling in fingers or toes (peripheral neuropathy) is often temporary and can improve after you finish treatment
• dizziness
• changes in the way your heart works - you may have changes to your heart beat, feel dizzy, have shortness of breath or chest pain - contact your advice line if you have this. Rarely your heart might stop beating (heart attack)
• a build up of fluid in your body (oedema)

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include: 

• scarring on the air sacs of your lungs which can cause a dry cough, chest pain and shortness of breath

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms

• a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening

• a stroke or a bleed in the brain

• lung changes such as shortness of breath if you are having or had radiotherapy to the lungs (radiation pneumonitis) or tightness of the chest and wheezing

• bleeding from the back passage (rectum)

• bleeding in the bowel or stomach

• sore, inflamed skin in the food pipe (oesophagus)

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know

Other medicines, foods and drinks

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Women must not become pregnant for at least 6 months after the end of treatment. Men should not get someone pregnant for at least 3 months after treatment. 

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions 

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having.

Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, and yellow fever.

You can usually have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine

Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your immune system is weakened.

Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.