Pemetrexed
Pemetrexed is the chemotherapy that, with a platinum drug, became the first approved treatment for mesothelioma in 2004, and is still the backbone today.
EMPHACIS (2003): cisplatin-pemetrexed OS 12.1 vs 9.3 months versus cisplatin alone, the first randomised survival gain in mesothelioma. Now given with pembrolizumab (KEYNOTE-483) or bevacizumab (MAPS). Also standard in non-squamous NSCLC. Requires folic acid and vitamin B12 supplementation.
1.Enters cells via the reduced folate carrier
- Route
- Intravenous
- Schedule
- 500 mg/m² day 1 every 21 days with cisplatin 75 mg/m² or carboplatin AUC 5; 4-6 cycles, then optional maintenance
- Dose modifications
- Hold for creatinine clearance <45 mL/min; dexamethasone premedication for rash
- Monitoring
- Renal function and blood counts; folic acid and B12 supplementation
- Medicare
- Part B (clinician-administered)
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. HCPCS J9305 for Alimta; generics and Pemfexy/Pemrydi RTU have separate codes with different patient coinsurance.
- Commercial insurance
- covered on label
Multi-source generic; covered under the medical benefit without prior authorisation in most plans, as part of standard regimens. Plans increasingly prefer generic pemetrexed over Alimta.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
- Appraised for
- First-line treatment of non-squamous NSCLC with cisplatin
- Notes
- Also malignant pleural mesothelioma (TA135, 2008) and maintenance (TA190, TA402). Generic since 2016.
- NHS England
- Routinely funded for the appraised indication (or via managed access)
Sources: NICE TA181 · SMC advice: pemetrexed. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 2004 | Unresectable pleural mesothelioma with cisplatin |
| US | 2008 | Non-squamous NSCLC first line |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia (grade 3+) | — | 23% |
| Fatigue | 48% | — |
| Nausea | 82% | — |
| Rash | 16% | — |
Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
Trials
topRecruiting now (live from ClinicalTrials.gov)
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials in OnCo
Latest papers
topQuery for this drug: (TITLE:"Pemetrexed" OR ABSTRACT:"Pemetrexed" OR TITLE:"Alimta" OR ABSTRACT:"Alimta" OR TITLE:"and generics" OR ABSTRACT:"and generics") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Pemetrexed, not a curated reading list.
Pages like this
not linked directly; found by shared links- TermEpithelioid vs sarcomatoid (biphasic) mesothelioma
Shares BEAT-meso (ETOP 13-18), IND.227 / KEYNOTE-483, CheckMate 743, Histology → first-line choice in mesothelioma.
- PersonSolange Peters
Shares CheckMate 743, Mesothelioma, Non-small-cell lung cancer.
- ProductNintedanib
Shares LUME-Meso, Mesothelioma.
- ProductOptune / Optune Pax (TTFields)
Shares STELLAR, Mesothelioma, Non-small-cell lung cancer.
- InstitutionETOP IBCSG Partners Foundation
Shares BEAT-meso (ETOP 13-18), Mesothelioma, Non-small-cell lung cancer.
- TechnologyTumour treating fields (TTFields)
Shares STELLAR, Mesothelioma, Non-small-cell lung cancer.
- ProductVinorelbine
Shares Mesothelioma, Cytotoxic chemotherapy, Non-small-cell lung cancer.
- ProductHydroxyurea (hydroxycarbamide)
Shares DNA replication & origin licensing, Cytotoxic chemotherapy.