Single-dose dexamethasone for the prevention of pemetrexed associated cutaneous adverse reactions

Our plain-English summary of Single-dose dexamethasone for the prevention of pemetrexed associated cutaneous adverse reactions, by R. Elsoueidi, M.J. Lander, E.M. Richa, et al (Journal of Oncology Pharmacy Practice, 2016).

The study

• Authors: R. Elsoueidi, M.J. Lander, E.M. Richa, E.D. Adane
• Journal: Journal of Oncology Pharmacy Practice
• Published: 2016;22(2):271-4
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pemetrexed (Alimta®) is a novel anti-folate antimetabolite agent that is used in combination with cisplatin for the treatment of patients with unresectable malignant pleural mesothelioma and as a single agent or in combination with cisplatin for patients with locally advanced or metastatic non-small-cell-lung-cancer. Cutaneous adverse reactions are common side effects of pemetrexed for which the manufacturer recommends 3-day premedication with dexamethasone 4 mg by mouth twice daily-(the day before, the day of, and the day after treatment). Patients' adherence to this premedication regimen is of concern. We report 14 cases of metastatic non-small-cell-lung-cancer patients who were premedicated with a single dose of dexamethasone 20 mg prior to pemetrexed or pemetrexed-based chemotherapy. None of these patients reported a grade 3 or above skin reactions over the course of their treatments. These findings suggest that a single dose of dexamethasone 20 mg may be an alternative premedication regimen in patients with metastatic non small cell lung cancer receiving pemetrexed or pemetrexed-based chemotherapy.

© The Author(s) 2015.

In plain English

This article was a retrospective case series of 14 adults with metastatic non-small-cell lung cancer treated with the chemotherapy drug pemetrexed, alone or combined with cisplatin or carboplatin, at the Hazard Appalachian Regional Healthcare Cancer Center between September 2009 and December 2013. Pemetrexed is also approved, together with cisplatin, for unresectable malignant pleural mesothelioma, but this study included only patients with metastatic non-small-cell lung cancer and did not study asbestos exposure. The manufacturer recommends three days of dexamethasone, a steroid, to prevent skin reactions. Instead, these patients got a single 20 mg dose of dexamethasone, by mouth or by vein, 30 minutes before chemotherapy. The authors reviewed medical charts covering 89 treatment cycles and found that none of the 14 patients reported any skin reactions at follow-up visits. The authors concluded that lower steroid doses before pemetrexed may be feasible. They called their results preliminary because the study was retrospective, came from a single institution and was small, and they said larger trials are needed. Patients were not assessed between treatment cycles.

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: Retrospective case series (chart review) at a single institution
• Who was studied: 14 patients (7 women, 7 men; mean age 60.2 years) with metastatic non-small-cell lung cancer treated with pemetrexed or pemetrexed-based chemotherapy at the outpatient Hazard Appalachian Regional Healthcare Cancer Center (Hazard, Kentucky, USA), September 2009 to December 2013. No mesothelioma patients were included.
• Exposure: A single 20 mg dose of dexamethasone given 30 minutes before pemetrexed (500 mg/m2), alone or with cisplatin or carboplatin. The text says 8 patients got it by mouth and 6 intravenously, but Table 1 reverses these numbers. Asbestos exposure was not studied.
• Main results:
  • None of the 14 patients reported any skin (cutaneous) reactions of any grade at follow-up visits.
  • The 14 patients received 89 treatment cycles in total. 39 cycles (44%) were pemetrexed alone and 50 cycles (56%) were pemetrexed combined with carboplatin or cisplatin.
• The authors' conclusion: The authors concluded that their results, with those of other studies, suggest that reduced steroid doses before pemetrexed are feasible and may decrease skin reactions. They called the results preliminary and said larger trials are needed.
• Limitations the authors state:
  • The study was retrospective, from a single institution, and had a small number of patients, so final recommendations cannot be made.
  • Patients were seen only at each 3-week cycle. No assessments or patient interviews were done between cycles.
  • Skin reactions during radiation treatment were not evaluated.

Topics

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Cisplatin, Unresectable, Pleural Mesothelioma, Chemotherapy, Small Cell Lung Cancer.

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• Pharmacokinetics of aprepitant and dexamethasone after administration of chemotherapeutic agents and effects of plasma substance P concentration on chemotherapy-induced nausea and vomiting in Japanese cancer patients — T. Takahashi, Y. Nakamura, et al. (2011)
• Pemetrexed-Induced Rash May Be Prevented by Supplementary Corticosteroids — T. Sakurada, S. Kakiuchi, et al. (2015)
• Pemetrexed induced acute kidney injury in patients with non-small cell lung cancer: reversible and chronic renal damage — G. Rombolà, F. Vaira, et al. (2015)
• Safety of Same-Day Vitamin B12 Supplementation in Patients Receiving Pemetrexed for the Treatment of Non-Small-Cell Lung Cancer or Pleural Mesothelioma: A Retrospective Analysis — Z. Schlei, W. Tan, et al. (2018)

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