Nursing considerations for administering pemetrexed (Alimta) in combination with cisplatin for malignant pleural mesothelioma

Our plain-English summary of Nursing considerations for administering pemetrexed (Alimta) in combination with cisplatin for malignant pleural mesothelioma, by K.K. Orbaugh (Clinical Journal of Oncology Nursing, 2004).

The study

• Author: K.K. Orbaugh
• Journal: Clinical Journal of Oncology Nursing
• Published: 2004;8(3):242-7
• Type of article: Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

No known cure exists for malignant pleural mesothelioma (MPM). The prognosis for patients with this relatively rare, asbestos-related malignancy of the pleural lining of the lung is quite poor. MPM treatment includes surgery, radiotherapy, and chemotherapy. Few patients, however, are candidates for surgery or radiotherapy, so chemotherapy is the only option for most patients. A phase III study found that pemetrexed and cisplatin chemotherapy significantly improved survival and had greater antitumor activity than cisplatin alone. The U.S. Food and Drug Administration recently approved pemetrexed with cisplatin for treating MPM. Nurses should become familiar with the proper preparation and administration of pemetrexed, including the necessity of supplementation with folic acid and vitamin B12. As with all drugs, careful attention must be paid to patient selection, laboratory monitoring, contraindications, and appropriate interventions in the event of adverse reactions or overdose.

In plain English

This article was a review written for oncology nurses, not an original study. The author summarized published trials on pemetrexed (Alimta), a chemotherapy drug, given with cisplatin for malignant pleural mesothelioma. The article describes this cancer as associated with asbestos exposure, but it did not study asbestos exposure. The main trial described was a phase III study by Vogelzang and colleagues (2003). In it, 226 patients received pemetrexed plus cisplatin and 222 received cisplatin alone. Median survival was 12.1 versus 9.3 months, one-year survival was 50% versus 38%, and response rates were 41.3% versus 16.7%. Before folic acid and vitamin B12 supplements were added, three drug-related deaths (7%) occurred among 43 patients. In an earlier phase II trial of 64 patients, severe neutropenia (a fall in infection-fighting white blood cells) affected 52.4% of unsupplemented patients and 9.3% of supplemented patients. The author concluded that nurses must become knowledgeable about preparing and giving pemetrexed. The author disclosed writing assistance from a firm paid by the drug's manufacturer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review (feature article) for nurses of published pemetrexed trials and the manufacturer's prescribing information
• Who was studied: No patients were studied by the author. The main trial reviewed was a phase III trial (Vogelzang et al., 2003) of 226 patients with MPM given pemetrexed and cisplatin versus 222 given cisplatin alone.
• Exposure: Not an asbestos-exposure study. The treatment reviewed was pemetrexed given with cisplatin. The article only states that MPM is associated with asbestos exposure and gives no exposure data.
• Main results:
  • In the phase III trial reviewed (Vogelzang et al., 2003), median survival was 12.1 months with pemetrexed and cisplatin versus 9.3 months with cisplatin alone.
  • In the same trial, one-year survival was 50% with pemetrexed and cisplatin versus 38% with cisplatin alone (p = 0.012).
  • In the same trial, response rates were 41.3% in the combination arm and 16.7% in the cisplatin-alone (control) group (p less than 0.001).
  • In the same trial, before vitamin supplementation was introduced, three drug-related deaths (7%) occurred among 43 patients.
  • In the phase II single-agent trial reviewed (Scagliotti et al., 2003; 64 patients), grade 3 or 4 neutropenia occurred in 52.4% of unsupplemented patients versus 9.3% of patients who received folic acid and vitamin B12.
  • In the same phase II trial, median overall survival was 13.0 months for supplemented patients versus 8.0 months for unsupplemented patients.
  • Funding disclosure: the author received writing assistance from a communications firm that was paid by the manufacturer of Alimta.
• The authors' conclusion: The author concluded that, to realize the full benefit of adding pemetrexed to cisplatin, nurses must become knowledgeable about preparing and administering pemetrexed, including the need for folic acid and vitamin B12 supplementation.
• Limitations the authors state:
  • The author noted that patients with hepatic (liver) impairment had not been studied specifically.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Cisplatin, Pleural Mesothelioma, Prognosis, Chemotherapy.

Related studies

• Clinical and pharmacokinetic phase I study of multitargeted antifolate (LY231514) in combination with cisplatin — R. Thödtmann, H. Depenbrock, et al. (1999)
• Phase I trial of cisplatin, pemetrexed, and imatinib mesylate in chemonaive patients with unresectable malignant pleural mesothelioma — A.S. Tsao, N. Harun, et al. (2014)
• Pemetrexed disodium in combination with cisplatin versus other cytotoxic agents or supportive care for the treatment of malignant pleural mesothelioma — J. Green, Y. Dundar, et al. (2007)
• Complete pathological response to neoadjuvant pemetrexed/cisplatin in combination with regional hyperthermia in a patient with sarcomatoid peritoneal mesothelioma — S. Kruger, M.K. Angele, et al. (2014)
• Pharmacogenetics of pemetrexed combination therapy in lung cancer: pathway analysis reveals novel toxicity associations — A. Corrigan, J.L. Walker, et al. (2014)
• Pemetrexed in the treatment of malignant mesothelioma: results from an expanded access program in Germany — M. Reck, R.A. Stahel, et al. (2010)

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