pemetrexed and cisplatin
This leaflet gives information about a course of chemotherapy called pemetrexed and cisplatin. The leaflet will explain what this means and how and when it will be given. It will also tell you about any common side effects you may experience. Contact telephone numbers and details of how to get more information about this chemotherapy are at the end of this leaflet.
You should read this leaflet alongside the ' General information for patients undergoing chemotherapy' leaflet. If you have not received this, ask your nurse for a copy.
Why am I having pemetrexed and cacisplatin chemotherapy?
Your doctor has recommended this chemotherapy as it is highly effective in treating the type of cancer you have.
What is pemetrexed and cisplatin chemotherapy?
This is a treatment that includes two drugs called pemetrexed and cisplatin. As part of your treatment, we will also give you supplementary vitamins which you will have to take before starting your chemotherapy.
Why do I have to take the supplementary vitamins?
Taking vitamins before taking pemetrexed, as well as during and after taking it, will reduce the risk of serious side effects. We will give you a vitamin B12 injection a week before your chemotherapy. This will be repeated twice during your treatment. You will also need to take multivitamin tablets containing folic acid once a day starting a week before your chemotherapy. These need to be taken every day during your chemotherapy and for three weeks afterwards.
Will I need to take any other medicine before my chemotherapy?
Yes. We will give you steroid tablets called dexamethasone.
It is very important that you take the dexamethasone steroid tablets in order to reduce some of the side effects associated with this chemotherapy. You have to take the tablets for five days, starting on the day before your chemotherapy. You should take them with food. It is very important to take them as directed.
Will I need any tests before having my chemotherapy?
You will need a series of blood tests before starting your chemotherapy. One of these blood tests might contain EDTA. This is a blood test that helps us check that your kidneys are working well enough to cope with chemotherapy. If your doctor decides you need EDTA, you will need to be prepared to stay in hospital for between four and five hours.
How often will I have my chemotherapy?
In order for this treatment to be most effective, it is given at specific time intervals. These are called circles. It is usual to have pemetrexed and cisplatin treatment every three weeks for six cycles. Your doctor will discuss with you the exact number of cycles you will have.
How will my chemotherapy be given?
Your chemotherapy is given through a drip into a vein in the back of your hand or arm. Alternatively, we would suggest that a small tube called a PICC is inserted into a large vein in your upper arm. It will remain in place throughout your treatment. Your doctor or nurse will discuss this further with you. We have a leaflet that tells you more about PICC lines. Please ask if you would like a copy.
How often will I need to visit the hospital?
You will need to visit the hospital twice in each three-week cycle:
Appointment at the outpatient clinic - you will have a blood test and we will check how you are doing and discuss any problems you may have. This is to enable us to see how the chemotherapy is affecting you. If your blood results are satisfactory, we will prescribe chemotherapy for you. This appointment will usually be a few days before your chemotherapy appointment.
Chemotherapy appointment – you will spend around seven hours in one of the day case treatment areas. You should allow an extra half hour for your first visit. We will give you anti-nausea medicine, fluids and your chemotherapy.
You are welcome to bring someone to stay with you during your treatment. Space is limited in the waiting and treatment areas, so there is usually no room for more than one person. Treatment areas are not suitable for small children.
What are the possible side effects?
There are a number of possible side effects that can arise with this chemotherapy. The doctors, nurses and pharmacists can give you advice or answer any questions you may have.
It is very important before starting your chemotherapy:
- That you have had your vitamin B12 injection
- That you take your multivitamin tablets
- That you are taking your dexamethasone steroid tablets
Loss of hair
You should not lose your hair with this chemotherapy. However, some people's hair will thin slightly.
Illness
Nausea and vomiting are now uncommon as we will give you anti-nausea medicines, which are usually very effective. If you vomit more than once in 24 hours, even though you regularly take anti-nausea medication when you are home after your chemotherapy treatment, contact Velindre Cancer Center for advice. The phone number is on page 8.
Infections
Your risk of catching infections will be higher as this treatment can reduce your white blood cells which help fight infections. Contact Velindre Cancer Center immediately if you develop any signs of infection, for example, flu-like symptoms or a temperature above 37.5° centigrade. The phone number is on page 8.
Diarrhea
You may get diarrhea with this chemotherapy. If this happens, it is important to drink plenty of fluids. Medicine is available to control diarrhoea. If you open your bowel four times or more than is normal for you over a 24-hour period, contact Velindre Cancer Center immediately. The phone number is on page 8.
Fatigue and fatigue
Chemotherapy can make you feel more tired than usual. It is important to listen to your body and rest if you need to but you should continue with your normal activities if you feel able to do so. For some people, a little light exercise can be beneficial as well as rest.
Sore mouth
Your mouth may be sore or you may notice small ulcers. Follow the advice on looking after your mouth in the general chemotherapy leaflet. Your doctor may give you a prescription for mouthwash or medication to prevent or clear up any infection.
Effect on your kidneys
Cisplatin can affect the way your kidneys work. The EDTA test you will have before your chemotherapy will check how well your kidneys are working at the start of treatment. We will also monitor you carefully by taking regular blood tests throughout your treatment.
We always give cisplatin with plenty of fluids in the drip to reduce the effect on your kidneys. It is also important that you drink plenty of fluids for at least two days after each treatment. We suggest having a cup or glass of liquid every hour during the day and at night.
Other side effects
Skin rash
Pemetrexed may cause a rash or skin irritation. This can usually be prevented by taking the dexamethasone tablets as directed. Using a moisturizer may help. If the rash is uncomfortable, contact Velindre Cancer Council for advice. The phone number is on page 8.
Effects on your nerves
Cisplatin can damage the nerves in your hands and feet. You may lose feeling or have changes in sensation such as tingling or pins and needles. Although this is very rare, it is important to tell your doctor if this happens so that we can adjust your treatment before this side effect becomes permanent.
Cisplatin can also damage the nerves responsible for hearing but this is rare. If this happens, you may experience some degree of hearing loss and this could be permanent.
Some patients have sore or watery eyes. If this happens, tell your doctor or nurse at your next clinic appointment.
Chemotherapy treatment sometimes affects women's periods. They could get heavier, lighter or even stop altogether.
It is important that you do not become pregnant or become a father while you are having chemotherapy treatment as chemotherapy could harm the unborn baby.
Uncommon side effects
Pemetrexed can cause some heart problems. If you have a heart condition or are taking any heart medication, tell your doctor before starting chemotherapy.
Is it ok to take other medicines? ?
If you are taking other medicines, tell your doctor, nurse or pharmacist. There are a small number of medicines that you may need to avoid. Tell your doctor, nurse or pharmacist if you are taking any pain relievers as you should not take some anti-inflammatory tablets with pemetrexed.
You must also tell your doctor if you have recently received the Yellow Fever vaccine.
Patient information leaflets from manufacturers
Copies of patient information leaflets from drug manufacturers are available from Felindre Pharmacy, or on the internet at www.medicines.org.uk These leaflets give detailed information about individual drugs. We do not routinely distribute them as they do not usually provide information on drug combinations and can be difficult to read. Please ask if you would like a copy.
Contact telephone numbers
Felindre Cancer Center 029 2061 5888
Ask for the chemotherapy pager if you get sick at home and need immediate attention at any time of the day or night. For example, you should call in the case of:
- If you vomit more than once over a 24 hour period
- That you have a temperature of 37.5°C or higher
- If you open your bowels four or more times in a 24-hour period which is more than what is normal for you
- You have an uncomfortable rash on the skin
Pharmaceutical department 029 2061 5888 ext. 6223
Monday – Friday 9am – 5pm for inquiries about your medicines
Cancer helpline
Tenovus freephone 0808 808 1010
Monday – Friday 9am – 4.30pm for general cancer enquiries
This leaflet has been written by health professionals. The information in this leaflet is based on evidence. It was endorsed by doctors, nurses and patients. It is reviewed and updated every two years.
Revised February 2013 