Although most appreciate pemetrexed to be a well-tolerated drug, it is not without its potential downsides. A common side effect with maintenance is fatigue, and Dr Ramalingam believes that the problem is more evident with longer treatment and becomes concerned when patients have not fully recovered from their previous cycle. To potentially alleviate this toxicity, both faculty members generally dose reduce and extend treatment over 4-week cycles. Dr Ramalingam may also consider a treatment holiday in some instances. In terms of dermatotoxicity, most do not find it to be a common problem with pemetrexed.

Ciuleanu T et al. Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: A randomised, double-blind, phase 3 study. Lancet 2009;374(9699):1432-40. Abstract

Paz-Ares LG et al. PARAMOUNT: Final overall survival results of the phase III study of maintenance pemetrexed versus placebo immediately after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non-small-cell lung cancer. J Clin Oncol 2013;31(23):2895-902. Abstract