Carboplatin + pemetrexed

What this treatment is and how it works

Carboplatin and pemetrexed are used in selected non-squamous lung-cancer and mesothelioma settings. Carboplatin dosing is based partly on kidney function. Using medicines with different actions helps attack cancer cells in more than one way. Healthy cells can also be affected, causing side effects.

When it may be used

Your team may use this treatment in the following settings: Non-squamous non-small-cell lung cancer and selected mesothelioma settings. The choice depends on the exact diagnosis, stage, previous treatment, health and treatment aim. Treatment may aim to cure cancer, lower the risk of recurrence, or control cancer and symptoms, depending on the setting.

A listed use is not a claim that every brand is licensed for that use in every country. Your oncologist will explain why this treatment is appropriate for you.

Before treatment

Before starting, tell the team about previous cancer treatment, allergies, infection symptoms, heart, lung, kidney or liver disease, hearing or nerve problems, diabetes and all medicines you take. Discuss pregnancy, contraception and fertility. Ask for a written treatment calendar, supportive-medicine instructions and a 24-hour oncology contact number. Baseline blood tests usually include a full blood count and kidney and liver function; additional tests depend on the medicine and your health. Before chemotherapy that reaches the whole body, the team should check for current or past hepatitis B infection. If a test is positive, extra monitoring or antiviral treatment may be needed to prevent the virus becoming active again. The team will coordinate testing and treatment; do not delay urgent cancer treatment yourself.

How treatment is given and the schedule

Folic acid, vitamin B12 and the prescribed steroid plan are essential with pemetrexed. Anti-sickness treatment is also given. The product information specifies at least five daily folic acid doses in the seven days before the first pemetrexed dose, then daily throughout treatment and for 21 days after the last dose. A vitamin B12 injection is given in the week before the first dose and once every three cycles thereafter. Your team will arrange the doses and dates; report missed vitamins before treatment.

The dose is calculated for your treatment and health. Rest periods, delays or dose changes may be needed. Do not change doses or treatment dates yourself, except to follow specific instructions to stop a medicine and seek help for warning symptoms. The team will give you a revised plan when needed.

During an infusion, tell the nurse immediately about pain, burning, swelling or leaking around the cannula or line. Do not massage the area or apply heat or ice unless the team instructs you.

Tests and monitoring during treatment

Blood counts, particularly white cells and platelets, and kidney function are checked. Confirm folic acid and B12 use before each course.

At each review, describe symptoms since the previous dose, including problems that have already settled. Blood tests can detect effects before you feel them. Your team may delay, reduce, omit or stop a medicine if results or symptoms make this necessary. The decision depends on the exact protocol; a normal result does not make new symptoms safe to ignore.

Side effects: what to expect

Side-effect rates depend on the exact protocol, doses and other treatments. Frequencies from individual-drug labels cannot simply be added together or treated as regimen rates. The groups below describe the expected clinical pattern without assigning unsupported percentages.

You are unlikely to have all of these effects. This is not an exhaustive list. Tell the team about any new or troublesome symptom, including one not mentioned here.

Common or more frequent side effects

Other reported side effects (frequency varies)

These effects may be common in some treatment settings, less common in others, or have no reliable frequency estimate. Their position here does not mean they are necessarily less frequent or less serious.

Diarrhoea, rash, taste changes, eye symptoms and kidney-test changes can occur.

Report these at review, or sooner if worsening. Use the urgent guidance for symptoms that affect breathing, drinking, urination, walking, consciousness or bleeding.

Important serious side effects, including rare effects

Serious does not always mean rare. Where reliable incidence is unavailable, no numerical frequency is assigned. The action to take matters even when the likelihood is uncertain.

Severe infusion or allergic reaction

Itching, flushing, wheeze, dizziness, throat tightness or facial swelling can start during an infusion or later. Tell the nurse immediately. Severe breathing difficulty, collapse or sudden face/throat swelling is an emergency.

Significant kidney injury

Very little urine, persistent vomiting, worsening swelling or marked weakness needs urgent assessment. Kidney problems may first be detected on blood tests, which is why monitoring continues even when you feel well.

Inflammation or injury in the lungs

A new cough, breathlessness, chest discomfort or falling exercise tolerance needs urgent oncology contact. Severe or rapidly worsening breathing difficulty is an emergency. Infection and other causes must also be considered.

Severe skin reaction

A spreading painful rash, blisters, peeling skin, or sores in the mouth, eyes or genital area needs urgent medical assessment. Severe reactions may require treatment to be stopped by the team.

Practical advice for this treatment

Ask the pharmacist before taking non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen. Report unusual bruising or bleeding and any earlier platinum reaction.

Medicines, interactions and vaccinations

Give the oncology pharmacist a complete list of prescription medicines, over-the-counter products, vitamins, herbal and Ayurvedic remedies and supplements. Ask before starting anything new. Do not stop prescribed medicines, including anticoagulants or infection-prevention medicines, without a coordinated plan. Live vaccines are generally unsuitable while immunity is suppressed; discuss vaccine type and timing with the team. Non-live vaccines may be offered, although protection can be reduced. Follow any specific stop-and-call instructions for the cancer medicine on this page or in your written treatment plan.

• Carboplatin: Medicines that can affect the kidneys or hearing, including some antibiotics and diuretics, need review. Do not start anti-inflammatory painkillers or supplements without checking.
• Pemetrexed: Ibuprofen and some other anti-inflammatory pain medicines can increase toxicity, especially when kidney function is reduced. Ask exactly which medicines to avoid and on which days; do not apply one interval to every NSAID. Do not substitute oral B12 for the prescribed injection.

Pregnancy, fertility and breastfeeding

Chemotherapy can harm a developing baby and may affect fertility temporarily or permanently. Discuss sperm, egg or embryo storage before treatment when feasible. If you could become pregnant, or your partner could become pregnant, use effective contraception during treatment and for the drug-specific period afterwards. Ask for a written end date based on every medicine in your plan: the required period differs by product and can extend for months. Periods stopping does not guarantee infertility. Tell the team immediately about a suspected pregnancy. Do not breastfeed during treatment; restart only after the team confirms the interval for the exact medicine and formulation.

Everyday life

Gentle activity, regular meals and rest can help you cope. Prepare food hygienically and drink according to your individual fluid plan. Avoid smoking; ask whether alcohol is safe with your exact treatment and other medicines. Plan work, travel and driving around symptoms and monitoring visits. Do not drive if dizzy, sleepy, weak, visually affected or impaired by neuropathy. You can usually be close to family and friends: chemotherapy does not make you radioactive. Follow the unit’s instructions for handling urine, vomit, laundry and sexual precautions for the period it specifies.

When to contact the oncology team

Contact the oncology team the same day for persistent vomiting or diarrhoea, difficulty drinking, reduced urine, mouth pain affecting eating, new cough, jaundice, a painful or spreading rash, unusual bruising, worsening constipation or new nerve symptoms. Use the more urgent instructions for the particular symptom when given above. If the team cannot be reached and you are unwell, seek urgent medical care.

Write down your hospital’s daytime and out-of-hours numbers before treatment. CTI’s general contact details do not replace the emergency number provided by your treating hospital.

After treatment

Keep the planned blood tests and follow-up appointments after the last dose. Blood counts and immunity may take time to recover, and some effects can start or persist later. Contact the team about symptoms rather than waiting for a routine visit. Keep a treatment summary, including drug names, dates and any serious reactions, for future doctors. Response may be assessed with examination, scans or blood or marrow tests, depending on the cancer.

Words you may hear

NSAIDs

Non-steroidal anti-inflammatory drugs, such as ibuprofen; these are painkillers that can interact with some cancer medicines.

Mesothelioma

A cancer of the lining around organs, most often the lungs.

Frequently asked questions

Individual medicine guides

• Carboplatin
• Pemetrexed