Your treatment with ALIMTA

If you and your doctor have decided to treat your lung cancer with ALIMTA, it’s important to know that you’ll have a team to help you along the way. In this section, you’ll learn about how your treatment will be given. You’ll also learn about what additional medicines you should take during treatment, what side effects to expect, and how to handle them.

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How your initial treatment will be given

For ALIMTA and carboplatin (carbo) plus KEYTRUDA® (pembrolizumab)

Initial treatment with ALIMTA and carboplatin plus KEYTRUDAInitial treatment with ALIMTA and carboplatin plus KEYTRUDA

Your treatment with ALIMTA and carbo plus KEYTRUDA is usually given once every 21 days. This 3-week period is considered one treatment cycle. The “rest days” between treatments are a normal part of your treatment with ALIMTA.

Additional vitamins and medicines you will need

During your treatment with ALIMTA, it is very important to take additional medicines (including vitamin B12, folic acid, and corticosteroid) to lower your risk of harmful side effects. You will get your first vitamin B12 injection 7 days (1 week) before your first dose of ALIMTA, and then every 3 cycles. It is also important to take a daily folic acid supplement and a medicine called a corticosteroid. Your doctor will tell you when to take these medications and how much to take.

For ALIMTA with cisplatin

Initial treatment with ALIMTA/cisplatinInitial treatment with ALIMTA/cisplatin

Your treatment with ALIMTA plus cisplatin is usually given once every 21 days. This 3-week period is considered one treatment cycle. The “rest days” between treatments are a normal part of your treatment with ALIMTA.

Additional vitamins and medicines you will need

During your treatment with ALIMTA, it is very important to take additional medicines (including Vitamin B12, folic acid, and corticosteroid) to lower your risk of harmful side effects. You will get your first vitamin B12 injection 7 days (1 week) before your first dose of ALIMTA, and then every 3 cycles. It is also important to take a daily folic acid supplement and a medicine called a corticosteroid. Your doctor will tell you when to take these medications and how much to take.

How your maintenance treatment will be given

Following initial therapy with ALIMTA and carbo plus KEYTRUDA

ALIMTA maintenance treatment following ALIMTA and carbo plus KEYTRUDAALIMTA maintenance treatment following ALIMTA and carbo plus KEYTRUDA

Your doctor will decide how many treatments of KEYTRUDA you need.

Your doctor will decide if you are eligible for maintenance therapy with ALIMTA. You will have regular blood tests before and during your treatment with ALIMTA. Your doctor may adjust your dose of ALIMTA, delay your treatment, or stop treatment based on the results of your blood tests and on your general condition, including any side effects that you may have had.

ALIMTA for maintenance therapy

ALIMTA is approved by the FDA as a single agent (used alone) for maintenance treatment of patients with advanced nonsquamous non-small cell lung cancer (NSCLC) after you have received 4 cycles of chemotherapy that contains platinum for first treatment and your cancer has not progressed. Ask your doctor if maintenance treatment is right for you.

ALIMTA is not appropriate for people who have a different type of NSCLC called squamous cell.

Additional vitamins and medicines you will need

During your treatment with ALIMTA, it is very important to take additional medicines (including Vitamin B12, folic acid, and corticosteroid) to lower your risk of harmful side effects. You will get your first vitamin B12 injection 7 days (1 week) before your first dose of ALIMTA, and then every 3 cycles. It is also important to take a daily folic acid supplement and a medicine called a corticosteroid. Your doctor will tell you when to take these medications and how much to take.

Following initial therapy with ALIMTA and cisplatin

Maintenance treatment with ALIMTA following ALIMTA plus cisplatinMaintenance treatment with ALIMTA following ALIMTA plus cisplatin

ALIMTA for maintenance therapy

ALIMTA is approved by the FDA as a single agent (used alone) for maintenance treatment of patients with advanced nonsquamous non-small cell lung cancer (NSCLC) after you have received 4 cycles of chemotherapy that contains platinum for first treatment and your cancer has not progressed. Ask your doctor if maintenance treatment is right for you.

ALIMTA is not appropriate for people who have a different type of NSCLC called squamous cell.

Additional vitamins and medicines you will need

During your treatment with ALIMTA, it is very important to take additional medicines (including Vitamin B12, folic acid, and corticosteroid) to lower your risk of harmful side effects. You will get your first vitamin B12 injection 7 days (1 week) before your first dose of ALIMTA, and then every 3 cycles. It is also important to take a daily folic acid supplement and a medicine called a corticosteroid. Your doctor will tell you when to take these medications and how much to take.

You will have regular blood tests before and during your treatment with ALIMTA. Your doctor may adjust your dose of ALIMTA, delay your treatment, or stop treatment based on the results of your blood test and on your general condition, including any side effects that you may have had.

Understanding your treatment plan

Before you begin therapy, it is important for you to talk to your healthcare provider and ask all your questions.

Be sure to let your healthcare provider know:

  • If you have had a severe allergic reaction to any medicine that contains pemetrexed
  • About all of your medical conditions
  • If you have kidney problems
  • If you have had radiation therapy
  • If you are pregnant, planning to become pregnant, or nursing
  • If you are taking other medicines, including prescription and over-the-counter medicines, vitamins, and herbal supplements
  • If you have kidney problems and take a medicine that contains ibuprofen. You should avoid taking ibuprofen for 2 days before, the day of, and 2 days after receiving treatment with ALIMTA

As a part of your treatment, you will also receive additional medicines (including Vitamin B12, folic acid, and corticosteroid) to help reduce your risk of certain side effects.

  • You must take folic acid every day by mouth beginning 7 days before your first dose of ALIMTA. You must keep taking folic acid every day during the time you are being treated with ALIMTA, and every day for 21 days after you receive your last dose of ALIMTA
  • You will get your first Vitamin B12 injection 1 week before your first dose of ALIMTA, and then about every 9 weeks during treatment. Do not substitute oral vitamin B12 for the vitamin B12 injection
  • Your doctor will prescribe a medicine called a “corticosteroid” that you must take by mouth twice daily for 3 consecutive days, beginning the day before each treatment with ALIMTA to reduce the possibility of experiencing skin-related side effects (like rash)

You will also have regular blood tests before and during your treatment with ALIMTA. Your doctor may adjust your dose of ALIMTA or delay your treatment based on the results of your blood tests and on your general condition, including any side effects that you may have had.

Possible side effects

Most people taking ALIMTA for initial or maintenance treatment will have side effects. You should always tell your healthcare provider if you are experiencing any new or worsening symptoms.

Side effects to watch for with initial therapy

The most common side effects of ALIMTA with carbo plus KEYTRUDA

The most common side effects of ALIMTA and carbo in combination with KEYTRUDA are tiredness, constipation, vomiting, diarrhea, loss of appetite, nausea, rash, shortness of breath, and headache.

The most common side effects of ALIMTA with cisplatin

The most common side effects of ALIMTA with cisplatin are vomiting, swelling or sores in your mouth or sore throat, constipation, low white blood cell counts (neutropenia), low platelet count (thrombocytopenia), and low red blood cell counts (anemia).

These are not all the side effects of ALIMTA. Talk to your doctor about any side effect that bothers you or does not go away. To learn more, choose a side effect from the menu.

For more information about all of the side effects of ALIMTA, please talk with your healthcare team, see the Patient Prescribing Information and full Prescribing Information, or call 1-800-545-5979.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Choose a side effect for more information:

White blood cells help you fight infection. A low white blood cell count may give you a greater chance for infection. If you have any signs of infection or fever, tell your healthcare provider right away.
Red blood cells help carry oxygen from your lungs to the other parts of your body. A low red blood cell count is called anemia. If your red blood cell count is low, you may experience severe tiredness, appear pale, and become short of breath.
Platelets help your blood clot. A low platelet count puts you at more risk for bleeding. If you have a low platelet count, you may be asked to take some extra care. For example, you may need to avoid injury. It is important that you tell your healthcare provider right away if you see any signs of bleeding, such as unexplained bruising or blood in your stool (black, tarry stools).
Fever may be the first symptom of infection. There are medicines that may reduce a fever that can be given along with chemotherapy. If you have a temperature of 100.4°F or higher, you should call your healthcare provider right away. It could be a sign that you have an infection. This may be severe and could lead to death.
Chills may include shivering, paleness, and feeling cold. If you experience chills, contact your healthcare provider right away. It could be a sign that you have an infection. This may be severe and could lead to death.
You may experience severe tiredness or fatigue. If you do, it may help to balance your periods of activity with rest, increase your liquid intake, and follow a well-balanced diet.
It is important to tell your healthcare provider if you have nausea or vomiting. There are medicines that can help prevent this. Your healthcare provider can also help treat your constipation. It is important that you talk with them before you take any over-the-counter laxatives or stool softeners.
Diarrhea is frequent, soft, loose, or watery bowel movements. Tell your healthcare provider right away if you have diarrhea. It could mean that you have an infection or kidney problems, which may be severe and could lead to death. It is also very important that you talk with them before you take any over-the-counter diarrhea medicines.
You may lose your appetite and lose weight during your treatment. Talk to your healthcare provider if this is a problem for you.
You may get redness, sores, or ulcers in your mouth, throat, on your lips, or in the esophagus after ALIMTA treatment. Call your healthcare provider right away if this happens, or if you have pain or trouble drinking or swallowing food. Mouth sores could mean you have an infection, which may be severe and could lead to death.
Hair loss is rarely permanent. Talk with your healthcare provider about any hair loss that may happen.
Signs of nerve damage may include weakness, pain, a tingling sensation, and/or numbness. Numbness is most common in the toes and fingertips.
Radiation recall is a skin reaction that can happen in people who have received radiation treatment in the past and are treated with ALIMTA. Tell your healthcare provider if you get swelling, blistering, or a rash that looks like a sunburn in an area that was previously treated with radiation.

Side effects to watch for with maintenance therapy

Your side effects with maintenance treatment may not be the same as those with initial treatment. You should always tell your healthcare provider if you are experiencing any possible symptom or side effect.

To learn more, choose a side effect from the menu.

For more information about all of the side effects of ALIMTA, please talk with your healthcare team, see the Patient Prescribing Information and full Prescribing Information, or call 1-800-545-5979.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Choose a side effect for more information:

White blood cells help you fight infection. A low white blood cell count may give you a greater chance for infection. If you have any signs of infection or fever, tell your healthcare provider right away.
Red blood cells help carry oxygen from your lungs to the other parts of your body. A low red blood cell count is called anemia. If your red blood cell count is low, you may experience severe tiredness, appear pale, and become short of breath.
Platelets help your blood clot. A low platelet count puts you at more risk for bleeding. If you have a low platelet count, you may be asked to take some extra care. For example, you may need to avoid injury. It is important that you tell your healthcare provider right away if you see any signs of bleeding, such as unexplained bruising or blood in your stool (black, tarry stools).
You may experience severe tiredness or fatigue. If you do, it may help to balance your periods of activity with rest, increase your liquid intake, and follow a well-balanced diet.
It is important to tell your healthcare provider if you have nausea or vomiting. There are medicines that can help prevent nausea and vomiting.
Diarrhea is frequent, soft, loose, or watery bowel movements. Tell your healthcare provider right away if you have diarrhea. It could mean that you have an infection or kidney problems, which may be severe and could lead to death. It is also very important that you talk with them before you take any over-the-counter diarrhea medicines.
You may lose your appetite and lose weight during your treatment. Talk to your healthcare provider if this is a problem for you.
Radiation recall is a skin reaction that can happen in people who have received radiation treatment in the past and are treated with ALIMTA. Tell your healthcare provider if you get swelling, blistering, or a rash that looks like a sunburn in an area that was previously treated with radiation.

Create a list of questions for your doctor.

Knowing where to start is usually the hardest part of having a conversation about cancer. You may have so many questions that it’s hard to keep them all straight. Create your own list of questions for your doctor.

  • As you go through this site, click on the icon to add a topic and related questions to your list
  • When you’re done, you can delete individual questions from the list by clicking the icon or the discussion guide icon at the right of the page
  • When you’re ready, you can download your list of questions or email it to your doctor for your next visit
  • Or, to add suggested questions to your list based on where you are in treatment, click on the buttons below

When you talk with your doctor, consider bringing a friend or family member along to take notes.

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Frequently asked questions

Choose a question for more information about NSCLC and ALIMTA.

There are two main types of lung cancer: non-small cell lung cancer (also known as NSCLC) and small cell lung cancer (SCLC). The difference between them has to do with the type of cancer cells (histology), how quickly they grow, and how they respond to treatment.

NSCLC is further divided into squamous and nonsquamous types. Your doctor may have told you that you have “adenocarcinoma” or “large cell carcinoma.” These are two of the subtypes of nonsquamous NSCLC. “Advanced” cancers have usually spread from where they started to other parts of the body. ALIMTA therapy is approved to treat advanced nonsquamous NSCLC. It is not approved for another type of NSCLC called “squamous cell.”

ALIMTA may be given to you in combination with carbo (a common type of chemotherapy) and an immunotherapy called KEYTRUDA, or you may receive ALIMTA plus another chemotherapy drug called cisplatin, as your first treatment. ALIMTA may also be given as maintenance therapy or if your cancer has spread or come back after earlier chemotherapy. You will usually receive ALIMTA once every 21 days (3 weeks). .

Most patients taking ALIMTA will have side effects. The most common side effects of ALIMTA and carbo in combination with KEYTRUDA are tiredness, constipation, vomiting, diarrhea, loss of appetite, nausea, rash, shortness of breath, and headache.

The most common side effects of ALIMTA when given with cisplatin are vomiting, swelling or sores in your mouth or sore throat, constipation, low white blood cell counts (neutropenia), low platelet counts (thrombocytopenia), and low red blood cell counts (anemia).

The most common side effects of ALIMTA when given alone are tiredness, nausea, and loss of appetite.

Talk with your healthcare provider about any side effect that bothers you or that doesn't go away. These are not all the side effects of ALIMTA. For more information, ask your healthcare provider or pharmacist. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Tell your healthcare provider right away if you:

  • have any signs of infection, fever, bleeding, or severe tiredness
  • have a decrease in the amount of your urine
  • develop blisters, skin sores, skin peeling, or painful sores or ulcers in your mouth, nose, throat, or genital area
  • get any new or worsening symptoms of shortness of breath, cough, or fever
  • get swelling, blistering, or a rash that looks like a sunburn in an area that was previously treated with radiation

Your healthcare team or insurance company can help you figure out your coverage. You can also contact Lilly PatientOne at 1-866-4PatOne (1-866-472-8663) to discuss ways to cover your medicine.

Glossary

As you go through this site, you will notice words in bold, underlined type. When you tap or move your cursor over these words, a definition will pop up on your screen. Try it now: maintenance.

Carboplatin (carbo)
An anticancer drug used to treat many types of cancer. Like cisplatin, carboplatin contains platinum.
chemotherapy
This is a treatment with one or more anticancer drugs that are intended to kill cancer cells.
cisplatin
A drug used to treat many types of cancer. Cisplatin contains platinum.
constipation
A condition in which stool becomes hard, dry, difficult to pass, and less frequent.
corticosteroid
Any steroid hormone made in the adrenal cortex (the outer part of the adrenal gland).
diarrhea
Frequent and watery bowel movements.
First-line Therapy
This is the first course of chemotherapy given after a cancer diagnosis. Also referred to as “initial therapy.”
folic acid
A nutrient in the vitamin B complex that the body needs in small amounts to work properly and stay healthy.
histology
The specific types of cells that make up your tumor.
immunotherapy
A type of treatment that triggers the immune system or keeps it down to help fight cancer, infection, and other diseases.
initial therapy
This is the first course of chemotherapy given after a cancer diagnosis. Also referred to as “first-line therapy.”
maintenance therapy
After initial combination treatment with ALIMTA, you may be able to continue treatment with ALIMTA if your cancer hasn’t gotten worse. This is called “maintenance therapy.”
platinum
A metal that is an important part of some anticancer drugs, such as cisplatin and carboplatin.
Second-line Therapy
Sometimes cancer returns after chemotherapy. Doctors may recommend treatment with a different drug to help slow the cancer’s growth or to relieve symptoms. This is called “second-line therapy.”
stage
The extent of cancer in the body. Staging is based on the size of the tumor, whether lymph nodes contain cancer, and how far the cancer has spread.
tumor
An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous) or malignant (cancerous).
Vitamin B12
A nutrient in the vitamin B family that the body needs in small amounts to work properly. Vitamin B12 helps make red blood cells, DNA, RNA, energy, and tissues, and keeps nerve cells healthy.
Indications and Important Safety Information

What Is ALIMTA® (pemetrexed for injection) Approved For?

ALIMTA® (pemetrexed for injection) is approved by the FDA in combination with carboplatin (another chemotherapy drug) and pembrolizumab (an immunotherapy) as a first treatment for nonsquamous non-small cell lung cancer (NSCLC) that has spread. There are ongoing studies to verify how well ALIMTA works in combination with carboplatin and pembrolizumab.

ALIMTA is approved by the FDA in combination with cisplatin (another chemotherapy drug) for the first (initial) treatment of advanced nonsquamous non-small cell lung cancer (NSCLC), a specific type of NSCLC that has spread.

ALIMTA is approved by the FDA as a single agent (used alone) for maintenance treatment of patients with advanced nonsquamous non-small cell lung cancer (NSCLC) after you have received 4 cycles of chemotherapy that contains platinum for first treatment and your cancer has not progressed.

ALIMTA is approved by the FDA as a single agent (used alone) for the treatment of patients with recurrent, metastatic nonsquamous non-small cell lung cancer (NSCLC), a specific type of NSCLC, which has returned or spread after prior chemotherapy.

ALIMTA is not appropriate for people who have a different type of NSCLC called squamous cell.

Important Safety Information for ALIMTA

What is the most important information that I should know about ALIMTA?

ALIMTA can cause serious side effects including:

Low blood cell counts. Low blood cell counts can be severe, including low white blood cell counts (neutropenia), low platelet counts (thrombocytopenia), and low red blood cell counts (anemia). Your healthcare provider will do a blood test to check your blood cell counts regularly during your treatment with ALIMTA. Tell your healthcare provider right away if you have any signs of infection, fever, bleeding, or severe tiredness during your treatment with ALIMTA.

Kidney problems, including kidney failure. ALIMTA can cause severe kidney problems that can lead to death. Severe vomiting or diarrhea can lead to loss of fluids (dehydration) which may cause kidney problems to become worse. Tell your healthcare provider right away if you have a decrease in amount of urine.

Severe skin reactions. Severe skin reactions that may lead to death can happen with ALIMTA. Tell your healthcare provider right away if you develop blisters, skin sores, skin peeling, or painful sores, or ulcers in your mouth, nose, throat or genital area.

Lung problems (pneumonitis). ALIMTA can cause serious lung problems that can lead to death. Tell your healthcare provider right away if you get any new or worsening symptoms of shortness of breath, cough, or fever.

Radiation recall. Radiation recall is a skin reaction that can happen in people who have received radiation treatment in the past and are treated with ALIMTA. Tell your healthcare provider if you get swelling, blistering, or a rash that looks like a sunburn in an area that was previously treated with radiation.

Who should not take ALIMTA?

ALIMTA may not be appropriate for some patients. If you are allergic to pemetrexed, tell your doctor because you should not receive it. It is not known if ALIMTA is safe and effective in children.

What should I tell my healthcare provider before receiving ALIMTA?

Before receiving ALIMTA, tell your healthcare provider about all of your medical conditions including:

  • if you have kidney problems.
  • if you have had radiation therapy.
  • if you think you are pregnant, or are planning to become pregnant as ALIMTA can harm your unborn baby.
    • Females who are able to become pregnant should use effective birth control (contraception) during treatment with ALIMTA and for 6 months after the final dose. Tell your healthcare provider right away if you become pregnant or think you are pregnant during treatment with ALIMTA.
    • Males with female partners who are able to become pregnant should use effective birth control (contraception) during treatment with ALIMTA and for 3 months after the final dose.
  • if you are breastfeeding or plan to breastfeed, as it is not known if ALIMTA passes into breast milk. Do not breastfeed during treatment with ALIMTA and for 1 week after the final dose.

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Tell your healthcare provider if you have kidney problems and take a medicine that contains ibuprofen. You should avoid taking ibuprofen for 2 days before, the day of, and 2 days after receiving treatment with ALIMTA.

How is ALIMTA given?

It is very important to take folic acid by mouth and receive vitamin B12 injections from your healthcare provider during your treatment with ALIMTA to lower your risk of harmful side effects.

Your healthcare provider will prescribe a medicine called a corticosteroid for you to take 2 times a day for 3 days, beginning the day before each treatment with ALIMTA.

ALIMTA is given to you by intravenous (IV) infusion (injection) into your vein. The infusion is given over 10 minutes. You will usually receive ALIMTA once every 21 days (3 weeks).

What are the possible side effects of ALIMTA?

The most common side effects of ALIMTA when given alone are:

  • Tiredness
  • Nausea
  • Loss of appetite

The most common side effects of ALIMTA when given with cisplatin are:

  • Vomiting
  • Swelling or sores in your mouth or sore throat
  • Constipation
  • Low white blood cell counts (neutropenia)
  • Low platelet counts (thrombocytopenia)
  • Low red blood cell counts (anemia)

The most common side effects of ALIMTA when given with carboplatin and pembrolizumab are:

  • Tiredness
  • Constipation
  • Vomiting
  • Diarrhea
  • Loss of appetite
  • Nausea
  • Rash
  • Shortness of breath
  • Headache

ALIMTA may cause fertility problems in males. This may affect your ability to father a child. It is not known if these effects are reversible. Talk to your healthcare provider if this is a concern for you.

Your healthcare provider will do blood tests to check for side effects during treatment with ALIMTA. Your healthcare provider may change your dose of ALIMTA, delay treatment, or stop treatment if you have certain side effects. Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the side effects of ALIMTA. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

ALIMTA is available by prescription only.

For more information about all of the side effects of ALIMTA, please talk with your healthcare team, see the Patient Prescribing Information and full Prescribing Information, visit www.ALIMTA.com, or call 1-800-545-5979.

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