Discontinue therapy if any haematologic or non-haematologic Grade 3 or 4 toxicity after 2 dose reductions, or if Grade 3 or 4 neurotoxicity is observed. Radiation pneumonitis; radiation recall in patients who received RT wk or yr previously. Monitor patients for myelosuppression during therapy & not to be given until ANC returns to ≥1,500 cells/mm
3 & platelet count ≥100,000 cells/mm
3; acute tubular necrosis, decreased renal function & signs & symptoms of nephrogenic diabetes insipidus (eg, hypernatraemia). Patients w/ underlying risk factors including dehydration or pre-existing HTN, diabetes or CV risk factors. Patients treated w/ radiation either prior, during or subsequent to pemetrexed therapy. Monitor CBC including differential white cell & platelet count, & collect blood chemistry tests to evaluate renal & hepatic function prior to each chemotherapy. Take folic acid & vit B
12 as prophylactic measure to reduce treatment-related toxicity. Consider drainage of 3rd space fluid collection prior to treatment. Ensure adequate anti-emetic treatment & appropriate hydration prior to &/or after receiving treatment. Not recommended in concomitant use w/ live attenuated vaccines. Avoid concomitant use w/ NSAIDs eg, ibuprofen, & ASA (>1.3 g daily) for 2 days before, on the day of, & 2 days following treatment in patients w/ mild to moderate renal insufficiency (CrCl 45-79 mL/min). Interrupt NSAIDs w/ long elimination t
½ for at least 5 days prior to, on the day of, & at least 2 days following treatment in patients w/ mild to moderate renal insufficiency eligible for pemetrexed therapy. Concomitant use w/ other radiosensitising agents. May cause fatigue & affect ability to drive & use machines. Not recommended in patients w/ CrCl <45 mL/min. Serious renal events including acute renal failure. Hepatic impairment eg, bilirubin >1.5x ULN &/or aminotransferase >3x ULN (hepatic metastases absent) or >5x ULN (hepatic metastases present). Women of childbearing potential should use effective contraception during & for 6 mth following treatment. Sexually mature males should use effective contraception & advise not to father a child during treatment & up to 3 mth thereafter, & to seek counselling on sperm storage before starting treatment. Not to be used during pregnancy. Discontinue lactation during therapy. Childn.
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