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Pemetrexed safety and dosing strategy

Lookup NU author(s): Professor Alan Calvert

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Abstract

Pemetrexed is a novel antifolate/antimetabolite that inhibits several folate-dependent enzymes, including thymidylate synthase, dihydrofolate reductase, and glycinamide ribonucleotide transformylase. As a class, antifolates have been associated with sporadic severe myelosuppression with gastrointestinal toxicity. Although infrequent, a combination of such toxicities carries a high risk of potentially life-threatening complications. Severe toxicity from pemetrexed-based therapy has become more predictable using the vitamin deficiency marker homocysteine and, to a lesser extent, methylmalonic acid. Evidence now suggests that reducing total plasma homocysteine levels by supplementation with folic acid and vitamin B12 leads to a better safety profile for pemetrexed, while not adversely affecting its efficacy. Copyright 2002, Elsevier Science (USA). All rights reserved.

Publication metadata

Author(s): Niyikiza, C., Hanauske, A., Rusthoven, J., Calvert, A. H., Allen, R., Paoletti, P., Bunn, P.

Publication type: Review

Publication status: Published

Journal: Seminars in Oncology

Year: 2002

Volume: 29

Issue: 6 supplement 18

Pages: 24-29

Print publication date: 18/12/2002

ISSN (print): 0093-7754

ISSN (electronic): 1532-8708

URL: http://www.seminoncol.org/article/S0093-7754(02)70042-0/abstract

PubMed id: 12571807

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