Pemetrexed Hexal
Antifolate Chemotherapy for Mesothelioma and Non-Small Cell Lung Cancer
Quick Facts About Pemetrexed Hexal
Key Takeaways About Pemetrexed Hexal
- Targeted cancer treatment: Pemetrexed is used to treat malignant pleural mesothelioma and non-squamous non-small cell lung cancer, often in combination with cisplatin or as maintenance therapy
- Mandatory vitamin supplementation: Folic acid and vitamin B12 must be taken before, during, and after treatment to significantly reduce the risk and severity of side effects
- Corticosteroid premedication required: Dexamethasone tablets must be taken the day before, on the day of, and the day after each infusion to reduce skin reactions
- Avoid NSAIDs around treatment: Non-steroidal anti-inflammatory drugs like ibuprofen can impair pemetrexed clearance and increase toxicity – timing restrictions apply
- Regular blood monitoring essential: Blood tests are required before each treatment cycle to ensure adequate kidney function, liver function, and blood cell counts
What Is Pemetrexed Hexal and What Is It Used For?
Pemetrexed Hexal is an intravenous chemotherapy medication classified as an antifolate antineoplastic agent. It is used to treat malignant pleural mesothelioma (a cancer of the lung lining) in combination with cisplatin, and advanced non-small cell lung cancer (NSCLC) of non-squamous histology in several treatment settings.
Pemetrexed belongs to a class of anticancer drugs known as antifolates. It works by interfering with multiple folate-dependent enzymes that are critical for DNA and RNA synthesis in rapidly dividing cells. Specifically, pemetrexed inhibits three key enzymes: thymidylate synthase (TS), dihydrofolate reductase (DHFR), and glycinamide ribonucleotide formyltransferase (GARFT). By simultaneously blocking these metabolic pathways, pemetrexed effectively disrupts the ability of cancer cells to replicate and grow.
In the treatment of malignant pleural mesothelioma (MPM), pemetrexed is given in combination with cisplatin as first-line chemotherapy for patients who have not previously received anticancer drug treatment. Malignant pleural mesothelioma is a rare and aggressive cancer that develops in the mesothelium, the thin membrane lining the lungs and chest wall. It is most commonly caused by prior exposure to asbestos fibres. The landmark EMPHACIS trial demonstrated that the combination of pemetrexed and cisplatin significantly improved survival compared with cisplatin alone in this disease.
For advanced non-small cell lung cancer (NSCLC), pemetrexed is approved for use in several clinical scenarios. It can be used with cisplatin as initial (first-line) treatment for patients with advanced or metastatic disease of non-squamous histology. It is also approved as maintenance therapy – meaning it can be continued as a single agent in patients whose disease has responded to or remained stable after initial platinum-based chemotherapy. Additionally, pemetrexed can be used as second-line therapy in patients whose cancer has progressed after other chemotherapy regimens.
It is important to note that pemetrexed is only approved for adult patients aged 18 years and over. There is no established role for pemetrexed in paediatric oncology. Furthermore, pemetrexed is specifically indicated for non-squamous histology NSCLC. Clinical trials have consistently shown that pemetrexed is less effective in patients with squamous cell lung cancer, and it is therefore not recommended for this subtype.
Pemetrexed was originally developed by Eli Lilly under the brand name Alimta and was first approved by the European Medicines Agency (EMA) in 2004. Pemetrexed Hexal is a biosimilar/generic version manufactured by Hexal A/S (part of the Sandoz/Novartis group). It contains the same active substance and has been shown to be bioequivalent to the originator product, meaning it provides the same therapeutic effect at the same dose.
What Should You Know Before Receiving Pemetrexed Hexal?
Before starting pemetrexed treatment, your oncologist must assess your kidney function, liver function, and blood cell counts. You must not receive pemetrexed if you are allergic to it, if you are breastfeeding, or if you have recently been vaccinated against yellow fever.
Contraindications
You should not receive Pemetrexed Hexal if any of the following apply to you:
- Allergy to pemetrexed or any of the other ingredients in this medicine, including sodium thiosulfate, propylene glycol, hydrochloric acid, sodium hydroxide, and water for injections
- Breastfeeding – you must stop breastfeeding during treatment with pemetrexed, as the drug may pass into breast milk and harm the infant
- Recent or planned yellow fever vaccination – live vaccines are contraindicated during pemetrexed treatment because the immunosuppressive effects of chemotherapy can lead to potentially fatal generalised vaccine disease
Warnings and Precautions
Talk to your doctor or pharmacist before receiving Pemetrexed Hexal. Several important precautions must be observed:
- Kidney function: Pemetrexed is primarily excreted by the kidneys. If you have or have had kidney problems, you may not be able to receive this medicine, or your dose may need to be adjusted. Creatinine clearance must be assessed before each treatment cycle
- Blood monitoring: Before each infusion, blood tests will be taken to check your kidney function, liver function, and blood cell counts. If your values are too low, your doctor may delay treatment or adjust the dose
- Cisplatin hydration: If you are also receiving cisplatin, your doctor will ensure you receive adequate intravenous fluids and anti-emetic treatment before and after the cisplatin infusion to prevent kidney damage and severe nausea
- Radiation therapy: If you have received or are planning to receive radiation therapy, inform your doctor. Pemetrexed and radiation can cause immediate or delayed adverse effects, including radiation recall dermatitis and radiation pneumonitis
- Recent vaccinations: Inform your doctor if you have recently received any vaccines, as pemetrexed may reduce the effectiveness of vaccines and potentially cause adverse reactions with live vaccines
- Heart disease: Tell your doctor if you have or have had any cardiovascular conditions, as cardiac side effects have been reported
- Pleural effusion: If you have fluid accumulation around the lungs, your doctor may decide to drain this fluid before starting pemetrexed treatment, as it can serve as a reservoir for the drug and prolong exposure to side effects
Pregnancy, Breastfeeding, and Fertility
Pregnancy: Pemetrexed must be avoided during pregnancy as it can cause harm to the unborn child. If you are pregnant, think you may be pregnant, or are planning a pregnancy, inform your doctor immediately. Women of childbearing potential must use effective contraception during treatment and for 6 months after the last dose of pemetrexed. Your oncologist will discuss the risks and may recommend alternative treatment options if pregnancy is a consideration.
Breastfeeding: You must not breastfeed during treatment with pemetrexed. It is not known whether pemetrexed passes into human breast milk, but given its mechanism of action, it could pose a serious risk to the nursing infant. Breastfeeding should be discontinued before treatment begins.
Fertility: Men are advised not to father a child during treatment and for up to 3 months after the last dose of pemetrexed. Effective contraception should be used throughout this period. Pemetrexed may impair fertility. If you plan to have children in the future, discuss sperm preservation with your doctor before starting treatment.
Driving and Operating Machinery
Treatment with pemetrexed can cause fatigue, dizziness, and nausea, which may impair your ability to drive or operate machinery safely. If you experience any of these symptoms after your infusion, do not drive or use machines until the effects have subsided. You are personally responsible for assessing your fitness to perform activities requiring alertness.
Sodium and Propylene Glycol Content
Pemetrexed Hexal contains sodium and propylene glycol as excipients. The sodium content varies by vial size: the 100 mg vial contains less than 1 mmol (23 mg) sodium and is essentially sodium-free, the 500 mg vial contains approximately 55.6 mg sodium (3% of the recommended maximum daily intake), and the 1000 mg vial contains approximately 111.2 mg sodium (6% of the recommended maximum daily intake). The propylene glycol content is 200 mg, 1000 mg, and 2000 mg per vial respectively. These excipient levels should be considered in patients on sodium-restricted diets or with propylene glycol sensitivity.
How Does Pemetrexed Hexal Interact with Other Drugs?
Pemetrexed can interact with NSAIDs (such as ibuprofen), proton pump inhibitors, nephrotoxic drugs, and live vaccines. Because pemetrexed is cleared by the kidneys, any drug that impairs renal function can increase pemetrexed levels and toxicity.
Pemetrexed is primarily eliminated unchanged through the kidneys. This means that any medication affecting kidney function can alter pemetrexed clearance and potentially increase the risk of serious side effects. Your oncologist will carefully review all your medications before starting pemetrexed treatment and advise on necessary timing adjustments or alternatives.
Major Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| NSAIDs (ibuprofen, naproxen, diclofenac) | Anti-inflammatory / Analgesic | Reduce renal clearance of pemetrexed, leading to increased drug levels and higher toxicity risk | Avoid for 2 days before and 2 days after infusion (5 days before if reduced kidney function) |
| Cisplatin | Platinum-based chemotherapy | Additive nephrotoxicity and myelosuppression; cisplatin reduces renal clearance of pemetrexed | Adequate hydration and anti-emetic premedication mandatory; monitor renal function closely |
| Nephrotoxic agents (aminoglycosides, vancomycin, amphotericin B) | Various (antibiotics, antifungals) | Can further impair renal function and delay pemetrexed clearance, increasing toxicity | Use with extreme caution; monitor kidney function frequently |
| Live vaccines (yellow fever, MMR, varicella) | Immunisation | Risk of potentially fatal generalised vaccine disease due to immunosuppression | Contraindicated during treatment; avoid for at least 3 months after last dose |
Moderate Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Proton pump inhibitors (omeprazole, esomeprazole, lansoprazole) | Acid suppressant | May reduce renal tubular secretion of pemetrexed; potential increase in pemetrexed exposure | Use with caution; inform your oncologist if you take these regularly |
| Aspirin (high doses) | NSAID / Antiplatelet | At high analgesic doses, may reduce pemetrexed clearance similarly to other NSAIDs | Low-dose aspirin (75–100 mg) for cardiovascular protection is generally safe; avoid high doses |
| Methotrexate and other antifolates | Antifolate / DMARD | Additive antifolate toxicity; increased risk of myelosuppression and mucositis | Avoid concurrent use; discuss with oncologist before combining |
| Warfarin and other anticoagulants | Anticoagulant | Chemotherapy may alter warfarin metabolism and increase bleeding risk due to thrombocytopenia | Monitor INR frequently; dose adjustments may be needed |
Always inform your oncologist about all medications you are taking, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Even seemingly harmless products can potentially interact with chemotherapy. Paracetamol (acetaminophen) is generally considered safe for pain relief during pemetrexed treatment but should be used under medical guidance.
What Is the Correct Dosage of Pemetrexed Hexal?
The standard dose of pemetrexed is 500 mg per square metre of body surface area, given as an intravenous infusion over approximately 10 minutes every 21 days. The dose is calculated based on your height and weight. Treatment must be accompanied by folic acid, vitamin B12, and corticosteroid premedication.
Pemetrexed Hexal must only be administered under the supervision of an oncologist experienced in the use of anticancer chemotherapy. The drug is prepared and administered by trained healthcare professionals in a hospital or infusion centre setting. You will never be asked to prepare or administer this medication yourself.
Adults
Standard Dose – All Indications
Dose: 500 mg/m² body surface area
Administration: Intravenous infusion over approximately 10 minutes
Cycle length: Every 21 days (3 weeks)
Your height and weight are used to calculate your body surface area (BSA). The oncologist uses this measurement to determine the precise volume of pemetrexed concentrate needed. This dose may be adjusted or treatment may be delayed based on your blood test results and overall health status.
When Given with Cisplatin
Pemetrexed: 500 mg/m² IV over 10 minutes
Cisplatin: Given approximately 30 minutes after pemetrexed infusion, also by IV infusion over approximately 2 hours
Adequate hydration is essential before and after cisplatin administration to protect the kidneys. Anti-emetic medication is given to prevent nausea and vomiting.
Mandatory Premedication
Three types of supplementary medication are required with every pemetrexed treatment cycle to reduce the risk and severity of side effects:
Corticosteroids
Medication: Dexamethasone 4 mg (or equivalent) twice daily
Timing: The day before, the day of, and the day after each pemetrexed infusion (3 days total)
Purpose: Reduces the frequency and severity of skin reactions associated with pemetrexed treatment
Folic Acid (Vitamin B9)
Dose: 350–1000 micrograms by mouth, once daily
Start: At least 5 doses during the 7 days before the first pemetrexed infusion
Continue: Daily throughout treatment and for 21 days after the last dose
Purpose: Protects normal cells from the antifolate effects of pemetrexed, reducing myelosuppression and mucositis
Vitamin B12
Dose: 1000 micrograms by intramuscular injection
Start: During the week before the first pemetrexed infusion
Continue: Every 9 weeks (approximately every 3 treatment cycles) throughout treatment
Purpose: Works synergistically with folic acid to reduce pemetrexed toxicity
Children and Adolescents
Pemetrexed Hexal is not recommended for use in children and adolescents under 18 years of age. There is no clinical experience with pemetrexed in the paediatric population, and no appropriate indications exist for this age group.
Dose Adjustments
Your oncologist may reduce the dose of pemetrexed or delay treatment based on the following factors:
- Low blood cell counts: If your neutrophil, platelet, or haemoglobin levels fall below certain thresholds, treatment may be delayed until recovery
- Kidney impairment: If creatinine clearance falls below 45 ml/min, pemetrexed is generally not recommended due to the increased risk of toxicity
- Severe mucositis or skin toxicity: Grade 3–4 non-haematological toxicities may require dose reduction by 75% of the previous dose
- General health status: Your overall condition and performance status are assessed before each cycle
Overdose
Pemetrexed overdose can cause severe bone marrow suppression (neutropenia, thrombocytopenia, anaemia), mucositis, and renal impairment. There is no specific antidote for pemetrexed overdose. In the event of a suspected overdose, blood cell counts should be monitored closely and supportive care including colony-stimulating factors (G-CSF) should be administered as clinically indicated. Because pemetrexed is given in a controlled hospital setting, overdose is extremely rare.
What Are the Side Effects of Pemetrexed Hexal?
Like all chemotherapy drugs, pemetrexed can cause significant side effects. The most common include low blood cell counts (myelosuppression), fatigue, nausea, vomiting, loss of appetite, mouth sores, skin rash, and abnormal kidney function. Mandatory supplementation with folic acid and vitamin B12 helps reduce these effects.
Not all patients will experience the same side effects, and the severity can vary considerably between individuals. Side effects are generally more frequent and severe when pemetrexed is given in combination with cisplatin compared with pemetrexed alone. Your oncology team will monitor you closely for side effects and provide supportive care as needed.
- Fever or signs of infection (temperature 38°C or above, sweating, chills) – you may have dangerously low white blood cell counts. Sepsis can be life-threatening
- Chest pain or rapid heart rate – may indicate cardiac complications
- Severe mouth pain, redness, swelling, or ulceration – severe mucositis requires medical intervention
- Severe skin rash, blistering, or skin peeling – may be signs of Stevens-Johnson syndrome or toxic epidermal necrolysis, which can be fatal
- Unusual bruising or bleeding (nosebleeds, bleeding gums, blood in urine) – may indicate very low platelet counts
- Sudden shortness of breath, chest pain, or coughing up blood – may indicate pulmonary embolism (blood clot in the lungs)
- Severe fatigue, paleness, or breathlessness – may indicate severe anaemia requiring transfusion
Very Common
May affect more than 1 in 10 people
- Infection
- Sore throat (pharyngitis)
- Low neutrophil count (neutropenia)
- Low white blood cell count (leukopenia)
- Low haemoglobin / anaemia
- Mouth sores, redness, and swelling (stomatitis/mucositis)
- Loss of appetite (anorexia)
- Nausea and vomiting
- Diarrhoea
- Skin rash and flaking skin
- Abnormal blood tests indicating reduced kidney function
- Fatigue and exhaustion
Common
May affect up to 1 in 10 people
- Blood infection (sepsis)
- Febrile neutropenia (fever with low neutrophils)
- Low platelet count (thrombocytopenia)
- Allergic reactions
- Dehydration
- Taste changes (dysgeusia)
- Motor neuropathy (muscle weakness)
- Sensory neuropathy (numbness, burning pain, unsteady gait)
- Dizziness
- Conjunctivitis (eye inflammation), dry eyes, watery eyes
- Heart failure, irregular heart rhythm
- Digestive problems, constipation, abdominal pain
- Liver enzyme elevation
- Increased skin pigmentation, itching, hives (urticaria)
- Hair loss (alopecia)
- Kidney failure, decreased kidney function
- Fever, pain, fluid retention (oedema)
- Chest pain
- Inflammation and ulceration of the digestive tract lining
Uncommon
May affect up to 1 in 100 people
- Pancytopenia (reduction of all blood cell types)
- Stroke or transient ischaemic attack
- Intracranial haemorrhage (bleeding inside the skull)
- Angina (chest pain from reduced blood flow to the heart)
- Myocardial infarction (heart attack)
- Coronary artery disease (narrowing or blockage)
- Pulmonary embolism (blood clots in the lungs)
- Gastrointestinal bleeding and intestinal perforation
- Oesophagitis (inflammation of the oesophagus)
- Colitis (inflammation of the colon)
- Radiation pneumonitis (lung inflammation from radiation interaction)
- Radiation recall dermatitis
Rare
May affect up to 1 in 1,000 people
- Haemolytic anaemia (destruction of red blood cells)
- Anaphylactic shock (severe allergic reaction)
- Hepatitis (liver inflammation)
- Skin erythema (redness)
- Radiation recall skin reactions
Very Rare
May affect up to 1 in 10,000 people
- Stevens-Johnson syndrome (severe skin and mucous membrane reaction, potentially life-threatening)
- Toxic epidermal necrolysis (severe skin reaction, potentially life-threatening)
- Skin and soft tissue infections
- Bullous skin conditions (fluid-filled blisters)
- Pseudocellulitis (inflammation of skin and subcutaneous fat)
- Dermatitis (various forms of skin inflammation)
Frequency Not Known
Cannot be estimated from available data
- Renal tubular disorder (damage to kidney tubular cells)
- Diabetes insipidus (primarily kidney-related)
- Increased urination and excessive thirst
- Hypernatraemia (elevated sodium levels in the blood)
If you experience any side effects not listed above, or if any side effect becomes severe, contact your oncology team promptly. Early intervention can prevent many side effects from becoming serious. Your healthcare team has extensive experience managing chemotherapy-related side effects and will provide appropriate supportive care.
How Should Pemetrexed Hexal Be Stored?
Pemetrexed Hexal must be stored at or below 25°C in its original packaging, protected from light. As a hospital-administered medication, storage is handled by pharmacy staff. Once opened, the vial must be used immediately.
Pemetrexed Hexal is stored and handled by hospital pharmacy staff according to strict protocols for cytotoxic medications. However, the following storage information is provided for completeness:
- Unopened vials: Store at or below 25°C. Keep in the original carton to protect from light
- After opening: The medicine should be used immediately. Any unused concentrate must be discarded according to local guidelines for cytotoxic waste
- After dilution (100 mg vials): The prepared infusion solution is stable for up to 3 days when refrigerated (2–8°C) and protected from light
- After dilution (500 mg and 1000 mg vials): Stable for up to 7 days at room temperature or 14 days when refrigerated (2–8°C), both protected from light
- Microbiological safety: From a microbiological perspective, the product should be used immediately after dilution. If not used immediately, the diluted solution should not be stored for longer than 24 hours at 2–8°C unless preparation occurred under controlled and validated aseptic conditions
Keep all medicines out of the sight and reach of children. Do not use Pemetrexed Hexal after the expiry date stated on the carton and vial label (after "EXP"). The expiry date refers to the last day of the stated month. Unused medicines should not be disposed of via household waste or wastewater. Ask your pharmacist about proper disposal of cytotoxic waste to protect the environment.
What Does Pemetrexed Hexal Contain?
The active substance is pemetrexed (as pemetrexed disodium hemipentahydrate) at a concentration of 25 mg/ml. It is available in 100 mg (4 ml), 500 mg (20 ml), and 1000 mg (40 ml) vials. Inactive ingredients include sodium thiosulfate, propylene glycol, hydrochloric acid, sodium hydroxide, and water for injections.
Pemetrexed Hexal is a concentrate for solution for infusion. It appears as a clear, colourless to yellow or green-yellow solution that is essentially free of visible particles. The solution is supplied in Type I glass vials sealed with bromobutyl rubber stoppers and aluminium caps with light blue plastic flip-off seals.
Active Substance
- Pemetrexed (as pemetrexed disodium hemipentahydrate) – 25 mg per ml of concentrate
- 100 mg vial: 4 ml concentrate containing 100 mg pemetrexed
- 500 mg vial: 20 ml concentrate containing 500 mg pemetrexed
- 1000 mg vial: 40 ml concentrate containing 1000 mg pemetrexed
Inactive Ingredients (Excipients)
- Sodium thiosulfate pentahydrate (E539)
- Propylene glycol (E1520)
- Hydrochloric acid (for pH adjustment)
- Sodium hydroxide (E524) (for pH adjustment)
- Water for injections
Preparation and Administration (Healthcare Professionals)
Pemetrexed solutions are for single use only. The required volume of pemetrexed concentrate is further diluted to 100 ml with sterile 0.9% sodium chloride solution (without preservatives) or sterile 5% glucose solution (without preservatives) and administered as an intravenous infusion over 10 minutes. Aseptic technique must be used throughout preparation. Gloves are recommended when handling the solution. If pemetrexed solution contacts the skin, wash immediately and thoroughly with soap and water. If it contacts mucous membranes, flush thoroughly with water. There is no specific antidote for pemetrexed extravasation; treat according to local protocols for non-vesicant agents.
Manufacturer: Fareva Unterach GmbH, Mondseestrasse 11, 4866 Unterach am Attersee, Austria. Marketing authorisation holder: Hexal A/S, Edvard Thomsens Vej 14, 2300 Copenhagen S, Denmark.
Frequently Asked Questions About Pemetrexed Hexal
Pemetrexed Hexal is an intravenous chemotherapy drug used to treat malignant pleural mesothelioma (a cancer of the lining of the lungs) in combination with cisplatin, and advanced non-small cell lung cancer (NSCLC) of non-squamous histology. It can be used as first-line therapy, maintenance therapy, or second-line therapy depending on the clinical situation. It is only for use in adults aged 18 years and over.
Folic acid and vitamin B12 supplementation is mandatory because pemetrexed works by blocking folate-dependent enzymes. Without supplementation, pemetrexed causes more severe side effects including dangerous drops in blood cell counts and severe mouth ulcers. Clinical trials showed that folic acid (350–1000 micrograms daily) and vitamin B12 (1000 micrograms injection every 9 weeks) dramatically reduce the incidence and severity of these toxicities without reducing the anticancer effectiveness of pemetrexed.
NSAIDs such as ibuprofen, naproxen, and diclofenac should be avoided around pemetrexed infusion days because they can reduce kidney function and delay clearance of pemetrexed, increasing toxicity. If you have normal kidney function, avoid NSAIDs for at least 2 days before and 2 days after your infusion. If your kidney function is reduced, avoid them for at least 5 days before and 2 days after. Paracetamol (acetaminophen) is generally considered safe and can be used for pain relief. Always consult your oncologist before taking any pain medication.
Pemetrexed is typically given once every 21 days (3 weeks), which constitutes one treatment cycle. Each infusion takes approximately 10 minutes. When given with cisplatin, the cisplatin is administered about 30 minutes after pemetrexed and takes approximately 2 hours. The total number of cycles depends on your response to treatment, the type of cancer being treated, and how well you tolerate the therapy. Your oncologist will determine the optimal duration of treatment for your specific situation.
No. Pemetrexed is specifically effective for non-squamous non-small cell lung cancer (NSCLC), which includes adenocarcinoma and large cell carcinoma subtypes. It is not recommended for squamous cell lung cancer, as multiple clinical trials have shown reduced efficacy in this histological subtype. Your oncologist will confirm the type of lung cancer through biopsy and pathological analysis before prescribing pemetrexed. It is also approved for malignant pleural mesothelioma regardless of histological subtype.
Before each pemetrexed infusion, your medical team will take blood tests to check: a complete blood count (white blood cells, red blood cells, and platelets), kidney function (creatinine and estimated glomerular filtration rate), and liver function tests. Treatment will only proceed if your blood values meet the minimum safety thresholds. If counts are too low, your treatment may be delayed by one or more weeks to allow recovery. These blood tests are essential for your safety and cannot be skipped.
References and Medical Sources
- European Medicines Agency (EMA). Pemetrexed – Summary of Product Characteristics. Available at: www.ema.europa.eu. Accessed December 2025.
- Vogelzang NJ, Rusthoven JJ, Symanowski J, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003;21(14):2636-2644. doi:10.1200/JCO.2003.11.136
- Hanna N, Shepherd FA, Fossella FV, et al. Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol. 2004;22(9):1589-1597. doi:10.1200/JCO.2004.08.163
- Scagliotti GV, Parikh P, von Pawel J, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008;26(21):3543-3551. doi:10.1200/JCO.2007.15.0375
- National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. Version 3.2025. Available at: www.nccn.org.
- European Society for Medical Oncology (ESMO). Clinical Practice Guidelines: Malignant Pleural Mesothelioma and Non-Small-Cell Lung Cancer. Available at: www.esmo.org.
- World Health Organization (WHO). Model List of Essential Medicines, 23rd List (2023). Available at: www.who.int.
- Paz-Ares L, de Marinis F, Dediu M, et al. Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with pemetrexed plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT). Lancet Oncol. 2012;13(3):247-255. doi:10.1016/S1470-2045(12)70063-3
Editorial Team
Medical content reviewed by the iMedic Medical Editorial Team – a team of licensed specialist physicians in oncology, clinical pharmacology, and internal medicine with documented academic backgrounds and clinical experience.
Board-certified specialists in oncology and clinical pharmacology. Members of ESMO and ASCO. All content follows the GRADE evidence framework.
Evidence Level 1A. Based on systematic reviews, randomised controlled trials, and international guidelines from WHO, ESMO, NCCN, and EMA. No commercial funding.