From the Guidelines
Carboplatin and pemetrexed are administered as an intravenous (IV) combination chemotherapy regimen, with pemetrexed given at a dose of 500 mg/m² on day 1, followed by carboplatin at an AUC of 5, also on day 1, and repeated every 3 weeks. This regimen is based on the most recent and highest quality study available, which demonstrated its efficacy and safety in patients with malignant pleural mesothelioma 1. The administration of pemetrexed and carboplatin involves an IV infusion over 10 minutes for pemetrexed, and 30-60 minutes for carboplatin.
Key Considerations
- Patients must take folic acid supplements and vitamin B12 injections to reduce the risk of side effects, as well as dexamethasone to reduce skin reactions.
- The dose of carboplatin is calculated using the area under the curve (AUC) formula, which takes into account the patient's renal function and body surface area.
- The combination of pemetrexed and carboplatin works by different mechanisms, providing complementary anti-cancer effects, with pemetrexed inhibiting enzymes needed for DNA synthesis and carboplatin forming DNA crosslinks.
Administration Details
- Pemetrexed is given first, as an IV infusion over 10 minutes, at a dose of 500 mg/m² of body surface area.
- Carboplatin is administered as an IV infusion over 30-60 minutes, with the dose calculated using the AUC formula, typically at an AUC of 5.
- The regimen is typically repeated for 4-6 cycles, though duration may vary based on response and tolerability, as supported by the study published in the Journal of the National Comprehensive Cancer Network 1.
From the FDA Drug Label
Carboplatin injection is usually administered by an infusion lasting 15 minutes or longer. Pemetrexed for Injection, USP ... For intravenous use only.
The combination of carboplatin and pemetrexed is given intravenously.
- Carboplatin is administered by an infusion lasting 15 minutes or longer.
- Pemetrexed is also given intravenously. 2 3
From the Research
Administration of Carboplatin and Pemetrexed
- Carboplatin and pemetrexed are administered every 3 weeks for a maximum of 6 cycles 4.
- The recommended dose of carboplatin is an area under the curve (AUC) of 5, and pemetrexed is 500 mg/m2 4, 5, 6.
- Pemetrexed maintenance therapy can be continued until disease progression or unacceptable toxicity is observed 5, 6.
Dosing and Administration
- Carboplatin dosing is based on the area under the curve (AUC) method, which takes into account the patient's glomerular filtration rate (GFR) 7.
- The Calvert equation is used to calculate the carboplatin dose, which is based on the patient's GFR and target AUC 7.
- Pemetrexed is administered at a fixed dose of 500 mg/m2 every 3 weeks 4, 5, 6.
Supplementation and Toxicity
- Vitamin B12 and folic acid supplementation is recommended to reduce hematologic toxicity associated with pemetrexed-based chemotherapy 4, 8.
- The incidence of hematologic toxicity, such as anemia, leukopenia, neutropenia, and thrombocytopenia, can be reduced with supplementation 4.
- However, toxic epidermal necrolysis has been reported in patients receiving pemetrexed and carboplatin with vitamin B12 and folic acid supplementation 8.