2 The technology

2.1 Pemetrexed disodium (Alimta, Eli Lilly and Company Limited) in combination with cisplatin has a marketing authorisation for the first-line treatment of patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) other than predominantly squamous cell histology.

2.2 Pemetrexed is an antifolate agent that works by disrupting folate-dependent metabolic processes essential for cancer cell replication and survival. Cisplatin is a platinum-based chemotherapeutic agent that has antitumour activity in a number of different cancers.

2.3 The licensed dose of pemetrexed is 500 mg/m² body surface area, administered as a 10-minute intravenous infusion on the first day of each 21-day cycle. It is followed approximately 30 minutes later by 75 mg/m² cisplatin infused over 2 hours. To reduce toxicity, patients treated with pemetrexed should receive folic acid and vitamin B12 supplements. To reduce the incidence and severity of skin reactions, premedication with a corticosteroid is recommended.

2.4 Adverse effects commonly associated with pemetrexed include nausea, vomiting, fatigue and leukopenia, particularly in the neutrophil component. Skin rash, mucositis and liver function abnormalities have also been reported. Cisplatin causes nausea and vomiting in the majority of patients. These adverse events are controllable in 50–80% of patients. Serious toxic effects of cisplatin on the kidneys, bone marrow and ears are common, and serum electrolyte disturbances, hyperuricaemia, allergic reactions and cardiac abnormalities have also been reported. For full details of side effects and contraindications, see the summaries of product characteristics.

2.5 The cost of pemetrexed is £800 for a 500-mg vial (excluding VAT, 'British national formulary' 57th edition). The cost per patient, assuming an average of four treatment cycles, is approximately £6400. Costs may vary in different settings because of negotiated procurement discounts.

  • National Institute for Health and Care Excellence (NICE)