Pemetrexed and cisplatin

Pemetrexed and cisplatin is a combination treatment used to treat non-small cell lung cancer and mesothelioma.

It is best to read this information with our general information about chemotherapy and the type of cancer you have.

Pemetrexed and cisplatin are given into a vein. You usually have this treatment as an outpatient. Your cancer doctor or nurse will tell you how often you will have it.

Chemotherapy drugs can cause side effects. Some of the side effects can be serious, so it is important to read the detailed information below.

Your healthcare team can give you advice on how to manage any side effects. Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we do not mention here.

Rarely, side effects may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is pemetrexed and cisplatin?

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


How pemetrexed and cisplatin are given

You will be given pemetrexed and cisplatin in the chemotherapy day unit. 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.

Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have chemotherapy.

You will see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.

Your nurse usually gives you anti-sickness (anti-emetic) drugs before the chemotherapy. The chemotherapy drugs can be given through:

  • a short thin tube 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 gives you this treatment as a drip (infusion). The pemetrexed is given over 10 minutes and the cisplatin infusion takes about two hours. You will be given extra fluids through your drip before and after the cisplatin. This is to protect your kidneys.

Your course of chemotherapy

You usually have a course of several cycles of treatment over a few months. Your nurse or doctor will discuss your treatment plan with you. Each cycle takes 21 days (three weeks). You have the pemetrexed and cisplatin on the first day of the cycle. You then have a rest period with no chemotherapy for 20 days. After these 21 days are complete, you start your second cycle of treatment.

PICC lines and central lines playlist

Watch our short animated videos about having PICC lines and central lines put in.

PICC lines and central lines playlist

Watch our short animated videos about having PICC lines and central lines put in.


About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.

You may also have some side effects that we haven’t listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for these drugs. The leaflet lists all known side effects.


Before you have pemetrexed and cisplatin

Before you start pemetrexed and cisplatin, you will be given medicines to help reduce side effects. These medicines include:

  • vitamin B12 injections
  • folic acid tablets
  • steroid tablets.

Vitamin B12

A nurse will give you an injection of vitamin B12 in the week before your first pemetrexed treatment. You will then have a vitamin B12 injection with every third pemetrexed treatment (about every nine weeks).

Folic acid

You will take a folic acid tablet every day. You usually start taking it five days before your first pemetrexed treatment and continue taking it until three weeks after your final treatment.

While you are having pemetrexed, you should not take folic acid supplements other than those your cancer specialist prescribes. Some multivitamins or food supplements contain folic acid. Check with your pharmacist before taking these.

Steroids

You will be given steroid tablets to help prevent skin reactions, such as an itchy rash. You take the steroids for three days, with each treatment, starting the day before you have pemetrexed. Always take your tablets exactly as explained to you by the nurse or pharmacist.


Side effects during treatment

Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

Allergic reaction

Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

  • feeling hot or flushed 
  • a skin rash
  • itching
  • shivering
  • feeling dizzy
  • a headache
  • feeling breathless 
  • swelling of your face or mouth
  • pain in your back, tummy or chest.

Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.

Sometimes a reaction can happen a few hours after treatment. If you get any signs or feel unwell after you get home, contact the hospital straight away.

The drug leaks outside the vein

If this happens it can damage the tissue around the vein. This is called extravasation. Extravasation is not common but if it happens, it is important that it is dealt with quickly. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein.

If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.


Common side effects

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Bruising and bleeding

Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor or nurse if you have any bruising or bleeding that you can’t explain. This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)

Chemotherapy can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is 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 blood cells. This is called a blood transfusion.

Feeling sick

You may feel sick in the first few days after chemotherapy. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least two litres (three and a half pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Constipation

This treatment can cause constipation. Here are some tips that may help:

  • Drink at least two litres (three and a half pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may 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 or delay treatment for a short time. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Loss of appetite

This treatment can affect your appetite. Do not worry if you don’t eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Feeling tired

Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Skin changes

Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect.

Pemetrexed can cause a rash, which may be itchy. If your skin feels dry, try using an unperfumed moisturising cream every day. If you have had radiotherapy recently or in the past, the area that was treated may become red or sore.

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.

Hair loss

Your hair may get thinner but you are unlikely to lose all the hair from your head. Hair loss usually starts after your first or second treatment. It is almost always temporary and your hair will usually grow back after treatment ends. Your nurse can talk to you about ways to cope with hair loss.

Eye problems

Your eyes may become sore and inflamed (conjunctivitis). Tell your doctor if this happens. They can prescribe eye drops to help.

A photo of Stuart talking about neutropenic sepsis

Neutropenic sepsis

Stuart talks about he how coped with neutropenic sepsis, an infection which can be a side effect of chemotherapy.

About our cancer information videos

Neutropenic sepsis

Stuart talks about he how coped with neutropenic sepsis, an infection which can be a side effect of chemotherapy.

About our cancer information videos

Watch our hair loss video playlist

In these videos, people with experience of cancer and hair loss share their stories. You can also watch tutorials on wigs, headwear and eye make up.

Watch our hair loss video playlist

In these videos, people with experience of cancer and hair loss share their stories. You can also watch tutorials on wigs, headwear and eye make up.


Less common side effects of pemetrexed and cisplatin

Changes to your taste

You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste bad or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.

Changes in hearing

Cisplatin can affect your hearing. You may have a hearing test before you start 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.

Effects on the kidneys

Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this. 

Before and after each treatment, your nurses will give you extra fluids through a drip. This is to protect your kidneys. It’s also important to drink at least two litres (three and a half pints) of fluids each day.  

If you pass less urine than usual, tell your nurse.

Effects on the heart

This treatment can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during, and sometimes after treatment. If the treatment is causing heart problems, your doctor can change the type of treatment you are having. 

Contact a doctor straight away if you:

  • have pain or tightness in your chest 
  • feel breathless or dizzy
  • feel your heart is beating too fast or too slowly.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor.

Effects on the lungs

Pemetrexed can sometimes cause changes to the lungs in people who have had radiotherapy to their chest. Always tell your doctor if you develop:

  • wheezing
  • a cough
  • a fever (high temperature)
  • breathlessness.

You should also let them know if any breathing problems you already have get worse. You may have tests to check your lungs.


Other information about pemetrexed and cisplatin

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain. 

If you have any of these symptoms, contact a doctor straight away. 

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Other medicines

Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Pemetrexed may interact with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin. If you take phenytoin, the chemotherapy can also affect how this works. There are other medicines that can react with this treatment. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.

Fertility

Some cancer drugs can affect whether you can get pregnant or father a child. If you are worried about this, it is important to talk with your doctor before you start treatment.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment. The drugs may harm the developing baby. It is important to use effective contraception.

Sex

If you have sex in the first few days after chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.


Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.