Pemetrexed-induced eyelid edema in lung cancer

Our plain-English summary of Pemetrexed-induced eyelid edema in lung cancer, by P.R. Martins-Filho, S.Y. Kameo, A.C. Mascarenhas-Oliveira, et al (The Journal of Craniofacial Surgery, 2013).

The study

• Authors: P.R. Martins-Filho, S.Y. Kameo, A.C. Mascarenhas-Oliveira, N.F. Vieira, E. Azevedo
• Journal: The Journal of Craniofacial Surgery
• Published: 2013;24(4):e401-3
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pemetrexed is a novel, multitargeted antifolate approved for the treatment of malignant pleural mesothelioma and non-small cell lung cancer. Although pemetrexed is a safe drug, some adverse effects such as myelosupression and cutaneous reactions are observed. Pemetrexed-induced eyelid edema is a rare side effect of pemetrexed treatment, and until this moment few cases were reported in the medical literature. We reported a new case of pemetrexed-induced eyelid edema in a patient with adenocarcinoma of the lung with brain metastases.

In plain English

This article was a case report describing one patient. She was a 61-year-old woman diagnosed in July 2011 with adenocarcinoma of the lung that had spread to the brain. Her cancer was lung adenocarcinoma, not mesothelioma. She received radiation to the brain metastases and the chemotherapy drug pemetrexed (500 mg/m2) with carboplatin on day 1 of each 21-day cycle, along with folic acid and vitamin B12. She developed anemia (hemoglobin 8.5 g/dL, hematocrit 27%) and, during the fifth course, grade II swelling of both eyelids, with no swelling or fluid retention elsewhere. Because other causes were ruled out, the doctors diagnosed a chemotherapy-related side effect. Daily furosemide (40 mg) and dexamethasone (10 mg) improved the swelling within 1 week. Because the chemotherapy was not changed, the swelling returned with every later course of pemetrexed. The authors set out this case in a table alongside five previously published cases. The authors concluded that dexamethasone appears to be a good option for managing this side effect, and they called for further studies. A single case report describes what happened to one person and does not show how often this occurs.

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: case report (one patient), with a table comparing it to five previously published cases
• Who was studied: one 61-year-old woman with adenocarcinoma of the lung with brain metastases, diagnosed July 2011; authors based in Sergipe, Brazil
• Exposure: pemetrexed (500 mg/m2) plus carboplatin (AUC 6) intravenously on day 1 of a 21-day cycle, with folic acid and vitamin B12, after radiation therapy to the brain metastases; no asbestos exposure is described
• Main results:
  • The patient developed anemia (Hb 8.5 g/dL; hematocrit 27%) without leukopenia or thrombocytopenia
  • Grade II swelling of both eyelids appeared during the fifth course of pemetrexed plus carboplatin
  • She had no swelling or fluid retention in other parts of the body
  • After other causes were excluded, the swelling was diagnosed as a chemotherapy-related adverse event
  • Daily furosemide (40 mg) and dexamethasone (10 mg) improved the swelling within 1 week
  • Because the chemotherapy was not changed, the eyelid swelling returned with each repeated course of pemetrexed
  • The authors tabulated this case with five previously published cases of eyelid edema with pemetrexed
• The authors' conclusion: The authors concluded that dexamethasone appears to be a good option for managing pemetrexed-induced eyelid edema, and that further studies are needed
• Limitations the authors state:
  • The authors noted that no risk factors for this side effect could be identified from the published patients

Topics

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Lung Cancer, Antifolate, Pleural Mesothelioma, Non-Small Cell Lung Cancer, Adenocarcinoma.

Related studies

• Pemetrexed-Associated Eyelid Edema: Effective Treatment by Excision of Lymphedematous Eyelid Tissue — N. Mangla, A. Carlson, et al. (2015)
• Death receptor 5 and cellular FLICE-inhibitory protein regulate pemetrexed-induced apoptosis in human lung cancer cells — L. Su, G. Liu, et al. (2011)
• Fatal pemetrexed-induced lung injury in patients with advanced mesothelioma: a report of two cases — K. Nagata, R. Kaji, et al. (2010)
• Pemetrexed in the treatment of malignant mesothelioma: results from an expanded access program in Germany — M. Reck, R.A. Stahel, et al. (2010)
• The role of pemetrexed in lung adenocarcinoma, mixed subtype with bronchioloalveolar carcinoma features — M. Duruisseaux, J. Cadranel, et al. (2010)
• Retreatment with pemetrexed-based chemotherapy in patients with malignant pleural mesothelioma — G.L. Ceresoli, P.A. Zucali, et al. (2011)

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