Incidence of cutaneous reactions with pemetrexed: Comparison of patients who received three days of oral dexamethasone twice daily to patients who did not

Abstract

Pemetrexed is a multitargeted antifolate indicated for locally advanced or metastatic non-squamous non-small-cell lung cancer and malignant pleural mesothelioma. Cutaneous reactions are associated with pemetrexed use. Pemetrexed prescribing information recommends oral dexamethasone 4 mg twice daily for three days starting the day before pemetrexed infusion to prevent cutaneous reactions. Patients receive intravenous dexamethasone before pemetrexed infusion at the University of New Mexico Comprehensive Cancer Center, but the oral dexamethasone recommendation is not always followed. The objective of this study was to determine if there is a difference between patients who received three days of oral dexamethasone starting the day before pemetrexed infusion and patients who did not by determining incidence of cutaneous reactions, delay in therapy, and therapy change due to adverse reactions. Eighty-five patients received at least one dose of pemetrexed between August 1, 2012 and August 31, 2017. Twenty-nine patients did not receive three days of oral dexamethasone 4 mg twice daily and 56 patients did (34.1% vs. 65.9%). There was no statistically significant difference in the incidence of cutaneous reactions between the intervention group and the control group (13.8% vs. 25.0%; p = 0.384), delay in pemetrexed therapy between groups (44.8% vs. 32.1%; p = 0.2), or therapy change due to adverse events (34.5% vs. 23.2%; p = 0.654). Results suggest three days of oral dexamethasone 4 mg twice daily did not significantly affect incidence rates of cutaneous reactions, delay in therapy, or therapy change in patients who received intravenous dexamethasone before pemetrexed infusion at University of New Mexico Comprehensive Cancer Center.

Immune-Related Adverse Events Are Associated With Clinical Benefit in Patients With Non-Small-Cell Lung Cancer Treated With Immunotherapy Plus Chemotherapy: A Retrospective Study

“…Third, the combination of immunotherapy plus chemotherapy includes a multidrug regimen, and adverse events may not necessarily be irAEs. For example, pemetrexed-induced skin rashes are commonly experienced in patients with NSCLC in the real-world setting ( 25 ). However, even if all our reported irAEs were not adverse events due to ICIs, irAEs may still be associated with the clinical efficacy of immunotherapy plus chemotherapy, as they were associated with prolonged PFS.…”

Edema of the face and extremities secondary to pemetrexed

“…While corticosteroid therapy may be effective prophylactic treatment against some pemetrexed-induced adverse events, skin toxicity still occurs in some cases despite premedication, as in our patient. 8 Edema progressing to sclerosis is an inflammatory process and is most often treated with additional systemic steroids and immunosuppressive agents, such as methotrexate. In the setting of active malignancy, we opted to manage conservatively with topicals, supportive care, and discontinuation of the offending agent.…”

Slowly developing toxic epidermal necrolysis-like reaction associated with pemetrexed and carboplatin

“…Supplementation of folic acid and vitamin B12 is routinely provided 1 week prior to chemotherapy aiming to minimise its cytotoxic effects, whereas the administration of oral or intravenous dexamethasone does not seem to reduce pemetrexed-associated cutaneous ADRs [4,5].…”