Oncura

Pemetrexed + Cisplatin: what to expect, day by day

Mesothelioma21-day cycle8 effects documented

An every-3-week infusion pair taken with vitamin supplements that reduce side effects. Cisplatin is strongly nausea-causing and needs generous IV fluids to protect the kidneys; hearing and nerve changes can build up over cycles.

Cisplatin + pemetrexed IV every 3 weeks (non-squamous NSCLC), given WITH folic acid + vitamin B12 + a steroid, which lower toxicity. Cisplatin's kidney, hearing, and nerve effects are CUMULATIVE (build over cycles); nausea can be delayed for days.

Get help straight away — this is true on any regimen, on any day.

A temperature of 100.4°F (38°C) or higher during treatment can mean a serious infection while your blood counts are low. Call your team or go to the ER — do not wait it out.

Also urgent: trouble breathing or chest pain · swelling of the face, lips or throat · new confusion or fainting · shaking chills · not being able to keep fluids down.

This is standing guidance shown to everyone. Nothing on this page is based on anything about you, and nobody is monitoring you.

One of the 8 entries below is marked provisional. They are shown because leaving them out would be its own distortion, but they have not yet been checked against the source document by a person, and they are not presented as authoritative. Every provisional entry is labelled where it appears.

Timed to the cycle

Day 1 is the day of your infusion. These are the effects a retrievable document ties to a day range for this regimen — not a prediction about you.

Neutropenia

Typically around days 18–39

A temporary drop in infection-fighting white cells. The vitamin supplements you take lower this risk.

Call your team urgently: A temperature of 100.4°F (38.0°C) or higher — an emergency.

reported by about 29% of people; severe in 15% · Timing from the manufacturer’s prescribing information · from Pemetrexed, Cisplatin

Anemia

Typically around days 18–39

A drop in red cells that can cause tiredness and breathlessness, building over cycles.

Call your team: New or worsening breathlessness or a racing heart.

reported by about 33% of people; severe in 6% · Timing from the manufacturer’s prescribing information · from Pemetrexed, Cisplatin

Not tied to a cycle day

These build with the number of doses, or are measured from when treatment started, so a cycle day would be the wrong shape for them. Each keeps the timing its own source states.

Nausea and vomiting

Sickness in the first 24 hours is the "acute" phase and usually peaks 2-3 hours in; anything from 24 to 120 hours is the "delayed" phase.

Cisplatin is one of the most nausea-causing drugs, so you'll get strong multi-drug prevention. Nausea can be delayed, lasting a few days after treatment.

Call your team: Can't keep fluids down for more than 12 hours.

reported by about 56% nausea (vomiting 40%) of people; severe in 7% · Timing from a clinical guideline · from Cisplatin

Kidney injury (nephrotoxicity)

cumulative, dose-dependent over cycles

Cisplatin can stress the kidneys, so you'll receive plenty of IV fluids before and after each dose. It can also lower magnesium and other salts. Your team checks kidney bloodwork each cycle.

Call your team: Passing much less urine than usual, or marked swelling.

reported by about 10% (creatinine rise) of people; severe in 1% · from Cisplatin

Peripheral neuropathy (cumulative)

delayed 3-8 weeks; builds over cycles; may be irreversible

Numbness or tingling in the hands and feet, often with a delayed onset (weeks in) that builds with repeated cycles and can persist — or briefly worsen — after stopping.

Call your team: Numbness that makes it hard to button clothes, walk, or feel the floor.

reported by about 9% of people; severe in 0% · from Cisplatin

Hearing changes (ototoxicity)PROVISIONAL

cumulative, dose-dependent (high-frequency)

Cisplatin can cause ringing in the ears or high-pitch hearing loss that builds with cumulative dose and may be permanent. Report any new ringing or hearing change promptly.

reported by about 10-30% of people · from Cisplatin

Fatigue

Tiredness that is often worst in the days after each infusion and can build over cycles.

reported by about 43% of people; severe in 7% · from Cisplatin, Pemetrexed

Rash

A skin rash that the steroid you take around treatment helps prevent. Tell your team if it's widespread or bothersome.

reported by about 7% of people; severe in 0% · from Pemetrexed

Where this comes from

S1. Pemetrexed (Alimta) FDA label = JMDB trial (Scagliotti, cisplatin+pemetrexed arm, fully supplemented) (2008) — PMID 18506025 / FDA label
S2. Cisplatin (Platinol) FDA prescribing information — FDA label

Timing windows on this page rest on:

MASCC/ESMO antiemetic consensus — emesis phases — “acute 0-24 h, delayed 25-120 h, overall 0-120 h” source
Cisplatin FDA prescribing information — “The nadirs in circulating platelets and leukocytes occur between days 18 to 23 (range 7.5 to 45) with most patients recovering by day 39” source
NCI PDQ — Fatigue (health professional) — “five distinct trajectories ... significant interindividual variability” source

A window appears here only where a retrievable document ties it to a drug in this regimen. Where nothing could be found, the window was removed rather than estimated — so a missing time is an honest gap, not an oversight.

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