Drug updated on 4/16/2024
| Dosage Form | Injection (intravenous; 100 mg, 500 mg) |
| Drug Class | Folate analog metabolic inhibitors |
| Ongoing and Completed Studies | ClinicalTrials.gov |
Indication
- Indicated in combination with pembrolizumab and platinum chemotherapy, for the initial treatment of patients with metastatic non-squamous non-small cell lung cancer (NSCLC), with no EGFR or ALK genomic tumor aberrations.
- Indicated in combination with cisplatin for the initial treatment of patients with locally advanced or metastatic, non-squamous NSCLC.
- Indicated as a single agent for the maintenance treatment of patients with locally advanced or metastatic, non-squamous NSCLC whose disease has not progressed after four cycles of platinum-based first-line chemotherapy.
- Indicated as a single agent for the treatment of patients with recurrent, metastatic non-squamous, NSCLC after prior chemotherapy.
Summary
- Pemetrexed (Alimta) is indicated for use in combination with pembrolizumab and platinum chemotherapy, as an initial treatment for patients with metastatic non-squamous non-small cell lung cancer (NSCLC), without EGFR or ALK genomic tumor aberrations.
- Three systematic reviews/meta-analyses were reviewed to gather information about the effectiveness and safety of pemetrexed (Alimta).
- One study found that maintenance therapy using bevacizumab plus pemetrexed resulted in prolonged progression-free survival (PFS) and overall survival (OS) compared to single-agent therapy, particularly among patients aged under 65 years, those with an Eastern Cooperative Oncology Group score of 0, and never-smokers.
- However, this same study also noted increased occurrences of adverse events such as anaemia, fatigue, thrombocytopenia and anorexia when using a combination of bevacizumab plus pemetrexed versus monotherapy.
- Another meta-analysis concluded that MTHFR 677 C > T polymorphism could not predict the efficacy of pemetrexed in NSCLC patients; however it suggested that the T allele may increase the risk of haematological toxicity during treatment.
- A third review showed significant improvement in PFS but not OS for advanced NSCLC patients treated with a combination maintenance therapy involving both pemetrexed and bevacizumab; yet it also highlighted statistically increased risks for provoking grade 3-4 adverse events compared to single-agent therapies.
Product Monograph / Prescribing Information
| Document Title | Year | Source |
|---|---|---|
| Alimita (pemetrexed) Prescribing Information. | 2022 | Lilly USA LLC, Indianapolis, IN |
Systematic Reviews / Meta-Analyses
Clinical Practice Guidelines
| Document Title | Year | Source |
|---|---|---|
| Non–small cell lung cancer, version 3.2022, NCCN clinical practice guidelines in oncology. | 2022 | Journal of the National Comprehensive Cancer Network |
| SEOM clinical guidelines for the treatment of malignant pleural mesothelioma (2020). | 2021 | Clinical and Translational Oncology |