title: Are 5-7 Days of Folic Acid Supplementation Necessary prior to Pemetrexed? Observations from a Case Series.
abstract: OBJECTIVE
  Current regulatory guidelines advise 5-7 days of folic acid supplementation prior to pemetrexed. Although taking folic acid during and after pemetrexed therapy is important, it remains unclear whether premedication is truly necessary, particularly as it can be inconvenient for patients, can contribute to their anxiety by delaying chemotherapy, and can create challenges in scheduling chemotherapy.
  
  
  RESULTS
  We retrospectively sought to identify and evaluate outcomes among non-small cell lung cancer patients who received less than the advised folic acid premedication. Only 8 patients were identified. However, upon critical examination of first-cycle chemotherapy outcomes, we observed no major adverse events with a shortened course of folic acid premedication.
  
  
  CONCLUSIONS
  In the very rare circumstance where urgent therapy is warranted, a healthcare provider can lookto this small case series and find modest precedent for the safe administration of pemetrexed in the absence of a full week of folic acid premedication.
authors.affiliation: Department of Medicine, Mayo Clinic, Cancer Center, Rochester, Minn., USA.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Griffin
authors.forename: Elisabeth K
authors.initials: EK
authors.lastname: Stephens
authors.forename: Aminah
authors.initials: A
authors.lastname: Jatoi
keywords: Adverse events; Folic acid; Pemetrexed; Premedication
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