With acceptable rates of toxicity, pemetrexed monotherapy with reduced doses might be a safe treatment among patients with renal insufficiency.
A study published in the Journal of Oncology Pharmacy Practice conducted this dose depended on the safety analysis of pemetrexed. Pemetrexed is an effective and well-tolerated drug for lung cancer. However, in patients with a creatinine clearance (CrCl) < 45 ml/min, this drug is not recommended due to increased cases of myelosuppression, who otherwise could be declared fit for the treatment.
In case of organ dysfunction, many drugs are used in a dose adjusted manner to match the safety standards. However, there was no similar study done attributed to pemetrexed so far.
This analysis opens the new doors of pemetrexed for patients with renal insufficiency. The research was conducted by Jordan Hill and colleagues at the James Cancer Hospital and Solove Research Institute at the Ohio State University.
It was a retrospective case series that involved a total of eighteen patients who obtained a minimum one dose of pemetrexed. On day 1 of each 21-day cycle of treatment, the drug was administrated as 10 minutes intravenous infusion. In treatment, the number of cycles was decided according to the treatment goal and tolerability. During the course, the drug was co-administrated with folic acid, dexamethasone and cyanocobalamin as per scheduled treatment. The measurement of toxicity was done using CTACE version 4.0. It is the common terminology criteria for adverse events.
As per the outcomes, the single-agent dose-adjusted pemetrexed can be given cautiously among patients with CrCl between 30 and 45 ml/min. However, pemetrexed as concomitant chemotherapy with platinum is not recommended among patients with CrCl < 30 ml/min. Even for 20% preemptive dose reduction an extra caution is needed for concomitant therapy because of high risk of grade ≥ 3 hematologic toxicity. Further reduction was not assessed among these patients. A further research analysis may be required.
