This leaflet provides information on a course of chemotherapy called pemetrexed and cisplatin. The leaflet will explain what this is and when and how it is given. It will also tell you about common side effects that you may experience. Contact telephone numbers and details of how to obtain further information on pemetrexed and cisplatin are given at the end of the leaflet.
This leaflet should be read alongside the ‘General information for patients receiving chemotherapy’ leaflet. If you haven’t received this then please ask your nurse for a copy.
Why am I having pemetrexed and cisplatin chemotherapy?
Your doctor has recommended this chemotherapy because it has been found to be effective in treating your type of cancer.
What is pemetrexed and cisplatin chemotherapy?
This is a chemotherapy treatment which consists of two drugs called pemetrexed and cisplatin. As part of your treatment we will also give you vitamin supplements which you must start before your chemotherapy.
Why must I take the vitamin supplements?
Taking vitamins before, during and after pemetrexed will reduce the risk of serious side effects. You will be given a vitamin B12 injection the week before your chemotherapy. This will be repeated twice during your treatment. You will also need to take multivitamin capsules containing folic acid once a day starting one week before your chemotherapy. These need to be taken every day during your chemotherapy and for three weeks after.
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 to reduce some of the side effects associated with this chemotherapy. You must take the tablets for five days, starting the day before you have your chemotherapy. They should be taken with food. It is very important to take them exactly as instructed.
Will I need any tests before I have my chemotherapy?
You will need a series of blood tests before you start your chemotherapy. One of these blood tests may include an EDTA. This is a blood test that helps us to check that your kidneys are working well enough to cope with chemotherapy. If your doctor decides you need an EDTA, you need to be prepared to be in the hospital for 4-5 hours.
How often will I receive my chemotherapy?
For this treatment to be most effective it is given at specific time intervals. These are known as cycles. 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 it may be suggested that a fine tube called a PICC is inserted into a large vein in your upper arm. This will remain in place throughout the course of your treatment. Your doctor or nurse will discuss this further with you if required, and we can give you a leaflet that tells you more about PICC lines if necessary.
How often will I need to visit the hospital?
You will need to visit the hospital twice in every three week cycle:
Outpatient clinic appointment – you will have a blood test and we will check how you are feeling and discuss any problems you may have. This is so we can check how the chemotherapy is affecting you. If your blood results are satisfactory, your chemotherapy will be prescribed. This appointment is usually a few days before your chemotherapy appointment.
Chemotherapy appointment – you will spend approximately seven hours on one of the day case treatment areas. Please allow up to an hour longer for your first visit. We will give you anti sickness medicine, fluids and your chemotherapy.
Can I bring relatives and friends with me?
You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person. Treatment areas are not suitable for young children.
What are the possible side effects?
There are a number of possible side effects which can occur with this chemotherapy. The doctors, nurses and pharmacists can give you advice or answer any questions you may have.
It is very important that before you start your chemotherapy you:
You should not lose your hair with this chemotherapy. However, a very small number of patients may experience some hair thinning.
Nausea and vomiting are uncommon these days as we will give you anti-sickness medicines which are usually extremely effective. If you are sick more than once in 24 hours despite taking regular anti-sickness medicine when you are at home after your chemotherapy treatment, contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
You are at an increased risk of picking up infections because your white blood cells which help fight infections can be reduced by this treatment.
If you develop an infection whilst your white blood cells are low, you are at risk of sepsis, this can be life threatening.
Contact Velindre Cancer Centre immediately if you develop any signs of infection, for example flu like symptoms or a temperature above 37.5°centigrade or below 35.5°centigrade The telephone number is at the end of the leaflet.
You may have diarrhoea with this chemotherapy. If this occurs it is important that you drink plenty of fluids. Medication is available to control diarrhoea. If you have four or more bowel movements in 24 hours above what is normal for you please contact Velindre Cancer Centre immediately. The telephone number is at the end of the leaflet.
Tiredness 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 carry out your normal activities if you feel able. Some people find it beneficial to take gentle exercise as well as rest.
Your mouth may become sore or you may notice small ulcers. Please follow the advice on caring for your mouth in the general chemotherapy leaflet. Your doctor may prescribe mouthwashes or medication to prevent or clear any infection.
Effect on your kidneys
Cisplatin can affect the way your kidneys work. The EDTA test which you 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 a cup or glass of fluid every hour during the day and evening.
A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further. It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.
Blood clots can be very serious. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.
Other side effects
Pemetrexed can cause skin rashes or irritation. These are normally prevented by taking the dexamethasone tablets as directed. Using a moisturising cream may help. If the rash becomes uncomfortable please contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
Effects on your nerves
Cisplatin may damage the nerves of your hands and feet. You may experience some numbness or changes in sensation such as tingling or pins and needles. Although this is very rare it is important that you tell your doctor at your next clinic visit if this happens so that we can modify your treatment before this side effect becomes permanent.
Cisplatin may also damage the nerves responsible for hearing, although this is rare. If this occurs you may experience some loss of hearing which may be permanent.
Some patients experience sore or watery eyes. If this happens please tell your doctor or nurse at your next clinic appointment.
Women sometimes find that chemotherapy treatment affects their periods. They could become heavier, lighter or even stop altogether.
It is important you do not become pregnant or father a child whilst having chemotherapy treatment as chemotherapy could damage the unborn baby. It is not advisable to breastfeed whilst receiving this treatment.
Rare side effects
Pemetrexed may cause some heart problems. If you have a heart condition or you take any heart medication, please tell your doctor before you start chemotherapy.
Is it alright to take other medicines?
If you are taking other medicines please tell your doctor, nurse or pharmacist. There are a small number of medicines that you may have to avoid. Please tell your doctor, nurse or pharmacist if you take any painkillers as some anti-inflammatory tablets must not be taken with pemetrexed.
You must also tell your doctor if you have recently received a Yellow Fever vaccine.
Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects.
Manufacturer’s patient information leaflets
Velindre leaflets provide information about very common and commonly reported side-effects (we are unable to list all of the common side effects), for more information regarding these and the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at www.medicines.org.uk. Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from Velindre pharmacy
Contact telephone numbers
Velindre Cancer Centre 029 2061 5888
Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night. For example you should phone if you:
Pharmacy department 029 2061 5888 ext 6223
Monday – Friday 9am – 5pm for queries about your medicines
Tenovus freephone 0808 808 1010
This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.
Reviewed July 2016