Pemetrexed and carboplatin
Pemetrexed and carboplatin is a combination chemotherapy treatment used to treat mesothelioma and non-small cell lung cancer.
This information is best read with our general information about chemotherapy and the type of cancer you have.
The two drugs used in this treatment are:
How pemetrexed and carboplatin are givenBack to top
You have pemetrexed and carboplatin in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
About a week before chemotherapy starts, your nurse will give you an injection of vitamin B12. You’ll have this injection again with every third treatment of pemetrexed and carboplatin.
You will also be given folic acid tablets to take. You will start taking these tablets at least five days before chemotherapy. You need to take them every day, usually until three weeks after your last chemotherapy treatment. The injection and tablets can help to reduce side effects.
Your doctor will prescribe steroid tablets for you to take the day before your chemotherapy. You need to take them for three days. They reduce the risk of getting a skin reaction to pemetrexed and help with other side effects. Take your tablets exactly as your nurse or pharmacist explains.
A few days before, or on the day of your treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will check your blood results and ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. This can take some time. Your nurse will tell you when your treatment is likely to be ready.
Your nurse gives you anti-sickness (anti-emetic) drugs as an injection into a vein or as tablets. They will give you the drugs and chemotherapy through one of the following:
- a short thin tube that the nurse puts into a vein in your arm or hand (cannula)
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse will give you pemetrexed as a drip (infusion) into your cannula or line over about 10 minutes. They will then give you the carboplatin as a drip. The drip is usually run through a pump, which gives you the treatment over about an hour.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy.
Rarely, carboplatin may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include:
- a rash
- feeling itchy, flushed or short of breath
- swelling of your face or lips
- feeling dizzy
- having pain in your tummy, back or chest
- feeling unwell.
Tell your nurse straight away if you have any of these symptoms.
Pain along the vein
If you have pain along the vein, tell your nurse straight away. They will check your drip site and slow the drip to ease the pain.
Your course of pemetrexed and carboplatin
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of pemetrexed and carboplatin usually takes 21 days (three weeks).
You have the pemetrexed and carboplatin on the first day of the cycle. You will then have a rest period with no chemotherapy for 20 days. At the end of the 21 days, you start your second cycle of treatment. This is exactly the same as the first cycle. You may have up to six cycles of pemetrexed and carboplatin. Your doctor or nurse will tell you the number of cycles you are likely to have.
Before you go home, the nurse or pharmacist will give you anti-sickness (anti-emetic) drugs to take. Take all your tablets exactly as they have explained.
Possible side effects of pemetrexed and carboplatin Back to top
We explain the most common side effects of pemetrexed and carboplatin here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these.
It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you.
Your nurse will give you advice about managing your side effects. After your treatment is over they will start to improve.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers to call the hospital if you feel unwell or need advice any time day or night. Save these numbers in your phone or keep them somewhere safe.
More information about this treatment
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).
Risk of infection
Pemetrexed and carboplatin can reduce the number of white cells in your blood. This will make you more likely to get an infection. When they are low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
- your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
Your white cells usually increase steadily and return to normal before your next treatment. You will have a blood test before having more chemotherapy. If your blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
Pemetrexed and carboplatin can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
Pemetrexed and carboplatin can also reduce the number of red cells in your blood. These cells carry oxygen around the body. If they are low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red cells (blood transfusion).
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. They may also give you a steroid drug to help. Take the drugs exactly as your nurse or pharmacist explained to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick, or vomit twice or more in 24 hours, contact the hospital on the numbers they gave you as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you. Some people may need to go into hospital for a short time so the doctors and nurses can control their sickness.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might advise you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Carboplatin may make you constipated and cause tummy pain. Drinking at least two litres (three and a half pints) of fluids every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and do regular, gentle exercise.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Your hair may thin, but you’re unlikely to lose all the hair from your head. The thinning usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. Your nurse can give you advice about coping with hair loss.
Changes in the way the kidneys work
Carboplatin can affect how your kidneys work. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your kidneys are working. Your nurse will ask you to drink plenty of fluid.
Less common side effects of pemetrexed and carboplatin Back to top
Changes in hearing
Carboplatin can affect your hearing but this isn’t common. During treatment you may get ringing in your ears (tinnitus) and lose the ability to hear some high-pitched sounds. Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing.
Pemetrexed and carboplatin may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.
Pemetrexed can cause a rash, which may be itchy. Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Numb or tingling hands or feet
These symptoms are caused by the effect of chemotherapy on nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but in some people they may never go away. Talk to your doctor if you are worried about this.
Your eyes may become watery and feel sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops.
It’s important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about pemetrexed and carboplatin Back to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some other medicines can interact with chemotherapy. Pemetrexed can interact with drugs like ibuprofen, piroxicam and aspirin. Medicines you can buy in a shop or chemist may also be harmful when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Pemetrexed and carboplatin may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in your semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You might not get a period every month and they may eventually stop. In some women this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them the contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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