title: [Safety of pemetrexed according to the duration of vitamin B12 and folic acid supplementation prior to the first dose of pemetrexed].
abstract: OBJECTIVE
  Administration of vitamin B12 and folic acid for 7 days prior to the administration of the first dose of pemetrexed is recommended. However, vitamin supplementation rarely is initiated less than 7 days prior to the first dose of pemetrexed. Therefore, we analyzed the safety of pemetrexed with vitamin supplementation for less than 7 days prior to the first dose of pemetrexed.
  
  
  METHODS
  Patients were classified into 2 groups according to the duration of vitamin supplementation prior to the first dose of pemetrexed: group A received vitamin supplementation for 7 days or more, and group B received vitamin supplementation for less than 7 days. We analyzed adverse effects, such as myelosuppression, rash, and diarrhea, after 1 cycle of pemetrexed therapy.
  
  
  RESULTS
  A total of 70 patients were administered pemetrexed; 40 patients were men and 30 were women with a median age of 64.5 years(range, 43-86 years). A total of 57 patients were classified into group A and 13 into group B; 33 patients were administered pemetrexed as a first-line treatment. Neutropenia of Grade 3 or more was observed in 4/49(8.2%)patients in group A and 2/13(15.4%)patients in group B(p=0.60). There were no significant differences in the rates of occurrence of neutropenia, rash, and diarrhea.
  
  
  CONCLUSIONS
  This retrospective study indicated that patients could be safely treated with pemetrexed if vitamin supplementation is initiated for less than 7 days prior to the first administration of pemetrexed. However, further studies are needed because of a lack of statistical power and adjustment for confounding factors.
authors.affiliation: Dept. of Pharmacy, St. Luke's International Hospital.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Tsuda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kitamura
authors.forename: Naoki
authors.initials: N
authors.lastname: Nishimura
authors.forename: Nao
authors.initials: N
authors.lastname: Yagi
authors.forename: Shinji
authors.initials: S
authors.lastname: Takayama
authors.forename: Kouhei
authors.initials: K
authors.lastname: Okafuji
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tomishima
authors.forename: Torahiko
authors.initials: T
authors.lastname: Jinta
authors.forename: Keiko
authors.initials: K
authors.lastname: Koyama
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ohde
authors.forename: Kazumi
authors.initials: K
authors.lastname: Gotoh
authors.forename: Naohiko
authors.initials: N
authors.lastname: Chohnabayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy; D003967:Diarrhea / Q000139:chemically induced / Q000517:prevention & control*; D019587:Dietary Supplements; D004338:Drug Combinations; D005076:Exanthema / Q000139:chemically induced / Q000517:prevention & control*; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D005971:Glutamates / Q000009:adverse effects* / Q000627:therapeutic use; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D000068437:Pemetrexed; D012189:Retrospective Studies; D014805:Vitamin B 12 / Q000008:administration & dosage*
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine; D005492:Folic Acid; D014805:Vitamin B 12