Briefing Note - pemetrexed (Alimta)_3

SMC accepted pemetrexed in combination with cisplatin for first-line treatment of patients with locally advanced or metastatic (spreading) non-small cell lung cancer that does not affect squamous cells (cells that line the airways). It is restricted to use in patients with particular types of non-small cell lung cancer (adenocarcinoma or large cell carcinoma).

• Non-small cell lung cancer (NSCLC) is a type of lung cancer. About 80 out of every 100 lung cancers are diagnosed as NSCLC, and it is usually caused by smoking.2 There are three types of NSCLC: squamous cell carcinoma, adenocarcinoma (cancer of airway cells that produce mucus) and large cell carcinoma (cancer of large cells in the airways). This SMC decision relates to the use of pemetrexed primarily in patients with adenocarcinoma or large cell carcinoma.
• NSCLC may be treated with surgery, drugs, radiation or by a combination of radiation and drugs. The treatment used depends on the size and spread of the cancer when it is diagnosed. Pemetrexed is a drug that works by blocking the growth of cancer cells. It is given through a drip.
• In patients with NSCLC that did not affect the squamous cells, treatment with pemetrexed and cisplatin showed a small improvement in patient survival compared with another cisplatin combination regimen.
• Fewer blood toxicities such as neutropenia, anaemia (low numbers of red blood cells) and thrombocytopenia (low numbers of a type of white blood cells called platelets) were reported, and fewer transfusions were administered in the pemetrexed and cisplatin group. Eye disorders, kidney failure, dry skin and pigmentation disorder were more likely to occur in patients treated with pemetrexed and cisplatin than with the other regimen.
• SMC accepted pemetrexed in combination with cisplatin for use in patients with particular types of NSCLC (adenocarcinoma or large cell carcinoma) because it offers some benefit to this group of patients at an acceptable cost.