New Regimen May Help Mesothelioma Patients Avoid Chemotherapy Skin Rash

2716186_pill2 copyA single dose of medicine prior to chemotherapy may be enough to ward off an uncomfortable side effect for mesothelioma patients, giving them one less thing to worry about prior to treatment. Doctors from four different US medical centers just released their findings on a new and potentially easier protocol for preventing pemetrexed-related skin rash.

Pemetrexed (Alimta) is the most popular drug for malignant pleural mesothelioma and remains the only drug approved specifically for this rare cancer.  It is also used to treat non-small cell lung cancer. Most patients on pemetrexed experience side effects, one of which is an itchy, blistering skin rash. While the rash is not usually serious, in some rare cases it can progress and even be fatal. About 16 percent of people on pemetrexed get the rash.

The good news is that pemetrexed-related skin reactions can be prevented in most mesothelioma patients by giving them a steroid called dexamethasone on the day before, the day of, and the day after chemotherapy. The catch is that patients have to remember to take the 4 mg pills twice a day on each of those three days. Missing even one dose can put them at increased risk for the rash.

But in a study published in the Journal of Oncology Pharmacy Practice, researchers say there may be an easier way to prevent the rash. They gave a single 20 mg dose of dexamethasone to 14 patients with non-small-cell lung cancer prior to pemetrexed treatment. None of these patients developed a serious skin rash over the course of their treatments.

“These findings suggest that a single dose of dexamethasone 20 mg may be an alternative premedication regimen in patients with metastatic non-small-cell lung cancer receiving pemetrexed or pemetrexed-based chemotherapy,” writes lead author Raymond Elsoueidi, MD, an oncologist/hematologist with Appalachian Regional Healthcare in Kentucky.

Other common side effects for mesothelioma patients on pemetrexed include a temporary drop in red and white blood cells and platelets, fatigue, nausea, vomiting and diarrhea. Mesothelioma patients typically get B12 injections and folic acid tablets before starting chemotherapy to offset potential deficiencies and their side effects.


Elsoueidi, R et al, “Single-dose dexamethasone for the prevention of pemetrexed associate cutaneous adverse reactions”, April 22, 2015, Journal of Oncology Pharmacy Practice, Epub ahead of print

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