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Predictive factors associated with pemetrexed acute toxicity.

Mathilde Bonnet1, Anne Jouinot2, Pascaline Boudou-Rouquette2,3

  • 1Pharmacie, Hôpital Cochin, Paris, France.

European Journal of Clinical Pharmacology
|March 23, 2023
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Summary

Pemetrexed chemotherapy can cause severe toxicities. Key predictors include low cystatin clearance, low albumin levels, and proton pump inhibitor use, guiding pre-treatment assessments for cancer patients.

Keywords:
AlbuminPemetrexedProton pump inhibitorsSarcopeniaToxicity

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Area of Science:

  • Oncology
  • Pharmacology
  • Clinical Medicine

Background:

  • Pemetrexed is effective for non-small cell lung cancer and mesothelioma.
  • Severe hematological toxicities are associated with pemetrexed chemotherapy.
  • Drug interactions may contribute to pemetrexed toxicity.

Purpose of the Study:

  • To identify predictive factors for pemetrexed toxicity.
  • To investigate the role of drug interactions in pemetrexed toxicity.

Main Methods:

  • Retrospective, open, monocentric study.
  • Included patients treated with pemetrexed.
  • Defined early limiting toxicities (ELT) based on Common Terminology Criteria for Adverse Events v5.0.
  • Used logistic regression to analyze associations with ELT.

Main Results:

  • 49% of patients experienced ELT.
  • Predictive factors for ELT included low cystatin clearance (p=0.0135), low albumin level (p=0.0333), and proton pump inhibitor use (p=0.035).

Conclusions:

  • Early limiting toxicities from pemetrexed are frequent in real-world cancer treatment.
  • Pre-treatment assessment should evaluate proton pump inhibitor use, sarcopenia, and nutritional status.