Cycle length: Every 21 days for a maximum of four cycles. | |||
Drug | Dose and route | Administration | Given on days |
Pemetrexed | 500 mg/m2 IV | Dilute with 100 mL NS* and administer over 10 minutes. Do not administer with calcium-containing IV fluids such as lactated Ringer solution. | Day 1 |
Carboplatin | AUC¶ = 5 mg/mL × min IV | Dilute in 250 mL NS* and administer over 30 minutes, beginning 30 minutes after pemetrexed. | Day 1 |
Pretreatment considerations: | |||
Emesis risk |
| ||
Prophylaxis for skin rashes |
| ||
Vesicant/irritant properties |
| ||
Infection prophylaxis |
| ||
Dose adjustment for baseline liver or kidney dysfunction |
| ||
Vitamin supplementation |
| ||
Monitoring parameters: | |||
| |||
| |||
Suggested dose modifications for toxicity:◊ | |||
Myelotoxicity |
| ||
Nonhematologic toxicity§ |
| ||
If there is a change in body weight of at least 10%, doses should be recalculated. |
ANC: absolute neutrophil count; AUC: area under the concentration × time curve; CBC: complete blood count; CrCl: creatinine clearance; GFR: glomerular filtration rate; IV: intravenous; NCCN: National Comprehensive Cancer Network; NS: normal saline; NSAIDs: nonsteroidal anti-inflammatory drugs.
* Diluent solutions should not be modified without consulting a detailed reference due to potential incompatibility(ies). There is also the option of a ready-to-use formulation of pemetrexed that requires no reconstitution, dilution, or refrigeration.[3]
¶ AUC is converted to a patient-specific carboplatin dose (in mg) according to kidney function by using the Calvert formula. The Calvert formula is total dose (mg) = (target AUC) × (GFR + 25). If using measured serum creatinine, limit the maximal GFR for the calculation to 125 mL/min. Refer to UpToDate topic on "Dosing of anticancer agents in adults".
Δ Consensus-based guidelines from the NCCN classify higher carboplatin doses (AUC ≥4) as highly emetogenic; by contrast, the American Society of Clinical Oncology and the Multinational Association for Supportive Care in Cancer guidelines consider all carboplatin doses to be moderately emetogenic. Although many institutions classify carboplatin-containing regimens as moderately emetogenic, a benefit for adding a neurokinin 1 receptor antagonist on day 1 has been shown in many studies; additional prophylaxis beyond day 1 for delayed emesis is not needed for most patients. Refer to UpToDate topic on "Prevention and treatment of chemotherapy-induced nausea and vomiting in adults".
◊ Dose adjustments in the study may differ slightly from that recommended by the manufacturer. The manufacturer's recommendations can be found in the United States Prescribing Information.[3,4]
§ Toxicity was graded using the Common Terminology Criteria of Adverse Events version 3.0.