Pemetrexed and carboplatin

Pemetrexed and carboplatin is the name of a chemotherapy combination. It includes the drugs we list below, next to each drug we have how you pronounce the drug name in brackets.

• pemetrexed (peh-meh-trek-sed) – this is also known as Alimta
• carboplatin –(car-bo-pla-tin)

It is a treatment for:

• non small cell lung cancer (NSCLC)
• mesothelioma that started in the layers of tissue that cover the lung (pleural mesothelioma)

How does pemetrexed and carboplatin work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do you have pemetrexed and carboplatin?

You have pemetrexed and carboplatin as a drip into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

How often do you have pemetrexed and carboplatin?

You have pemetrexed and carboplatin chemotherapy as cycles of treatment . This means you have the treatment and then a rest to allow your body to recover.

Each cycle usually lasts 3 weeks (21 days). Depending on your cancer type you might have up to 4 to 6 cycles which can take about 4 months.

A common way of having this treatment is as follows:

You then start a new cycle of treatment.

To help reduce the side effects of pemetrexed you might have the following medication. This depends on your circumstances. The following are examples, you might have:

• folic acid tablets starting at least 5 days before you begin treatment, continuing throughout treatment, and for 3 weeks after treatment ends
• vitamin B12 injections. You have one injection in the week before you start treatment and then one before every 3rd treatment cycle (every 9 weeks). You also have one a few weeks after your last pemetrexed

You may also have a steroid tablet to help with the side effects, starting on the day before your chemotherapy. You take the tablets twice a day, for up to 3 days with breakfast and lunch. 

Your doctor, nurse or pharmacist will explain what you need to take and when to take them.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of pemetrexed and carboplatin?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Try to avoid fatty or fried foods. Eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Rarely you may have bleeding from your lower bowel (rectum) or other areas of your digestive system . You may see blood in your poo or vomit blood. Contact your healthcare team straight away if you have any bleeding.   

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Fatigue

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Loss of appetite

You may not feel like eating with this treatment. Sickness, taste changes, and tiredness can put you off food and drinks.

Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Skin rash and other skin problems 

Skin problems include a skin rash, dry skin, itching and a burning feeling. This usually goes back to normal when your treatment finishes. Less commonly you may notice darker patches on your skin.

Rarely you might have a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel your eyes may be more sensitive to light. This is serious and could be life threatening.

Let your healthcare team know if you have any problems with your skin. They can tell you what products you can use or prescribe medicine to stop the itching and soothe your skin.

Kidney changes

You might have some changes in the way your kidneys work. You have regular blood tests to check how well they are working.

Less commonly your kidneys might stop working. Symptoms include feeling tired, feeling or being sick, confusion, swelling which may be more noticeable in your hands, ankles and face, and a poor appetite.

Contact your advice line if you have any of these symptoms.

Low level of minerals in the blood

Your blood contains different minerals, salts, proteins and enzymes. This treatment can cause low levels of minerals such as sodium, potassium, calcium and magnesium in your blood. Some minerals are more likely to cause symptoms than others. Low calcium and magnesium could cause muscle cramping or twitching.

In most cases low mineral levels are picked up on blood tests. 

Changes in how your liver works

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Rarely you might have inflammation of the liver (hepatitis) that can affect how your liver works.

Tummy (abdominal) cramps and pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Sore mouth and throat 

You may have a sore mouth and also have mouth ulcers. Your throat might also become sore and inflamed. It may be painful to swallow drinks or food. It helps to keep your mouth and teeth clean, drink plenty of fluids, and avoid acidic foods such as lemons. Chewing gum can help to keep the mouth moist. 

Painkillers and mouthwashes can help to reduce the soreness. Let your nurse and pharmacist know if you have any symptoms and check with them before you take painkillers.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• an allergic reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills
• indigestion or heartburn
• taste changes
• a high temperature (fever)
• numbness or tingling in hands, feet, arms and legs (peripheral neuropathy)
• changes in your hearing, such as ringing in your ears or problems with your inner ear affecting your balance
• problems with your muscles and joints and tendons, such as pain and weakness and a decreased tendon reflex
• eye problems - you may have blurred vision, or sore, red, watery, itchy eyes and you may have a discharge (conjunctivitis). You might also have swollen eyelids or a condition where your eyes are very dry. Rarely you may have loss of vision
• problems with your heart not pumping properly and an irregular heartbeat. Rarely you might have chest pain or a heart attack. Call 999 straight away of you have these symptoms
• a build up of fatty substances in the blood vessels around your heart
• lung changes such as shortness of breath due to inflammation and scaring. You might also have this if you are having or had radiotherapy to the lungs. You might also have tightness of the chest, wheezing and coughing
• lack of fluid in the body (dehydration)
• constipation
• hair thinning and hair loss
• a hole in part of your digestive tract. Symptoms include severe tummy pain and swelling, feeling or being sick and feeling hot and shivery. Let your healthcare team know straight away if you have these symptoms
• problems having a wee, you may find you wee more often or less often, and it can be painful. You might notice blood in or wee and it may have a bad smell
• feeling dizzy
• a build up of fluid (swelling) in your arms, hands, ankles, legs, face and other parts of the body

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• a skin rash over areas where you’ve previously radiotherapy
• poor blood supply to your limbs due to narrowing of the blood vessels, you might notice one leg or foot feels colder than the other, or they might feel weak or painful. You might also have cramp in your legs after walking or exercise
• a rare condition where your body breaks down its own red blood cells
• second cancers later in life
• a stroke
• inflammation in an area that was previously treated with radiotherapy. This may happen days or months after radiotherapy treatment

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

• pemetrexed
• carboplatin

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Non steroidal anti inflammatory drugs (NSAIDS)

Do not take non steroidal anti inflammatory drugs (NSAIDS) before speaking with your doctor or pharmacist first. NSAIDS can make the side effects of pemetrexed worse. There are different types of NSAIDS including ibuprofen. 

Your healthcare team can tell you exactly how long to avoid taking NSAIDS. Talk with your team if you have any worries about controlling your pain.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 6 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors advise that you don’t breastfeed during this treatment.

Other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.