1/21/2025

Janusmed kön och genus

Janusmed kön och genus – Pemetrexed Hexal

Janusmed kön och genus är ett kunskapsstöd som tillhandahåller information om köns- och genusaspekter på läkemedelsbehandling. Kunskapsstödet är avsedd främst för hälso- och sjukvårdspersonal. Texterna är generella och ska inte ses som behandlingsriktlinjer. Det är alltid behandlande läkare som ansvarar för patientens medicinering.

För att komma till startsidan för Janusmed kön och genus och för att göra sökningar klicka här.

Tillbaka till index
C! C!
C! C!

Pemetrexed

Pemetrexed

Klass : C!

Produkter

ALIMTA, Armisarte, Pemetrexed Accord, Pemetrexed EVER Pharma, Pemetrex......

ALIMTA, Armisarte, Pemetrexed Accord, Pemetrexed EVER Pharma, Pemetrexed Fresenius Kabi, Pemetrexed Hexal, Pemetrexed Mylan, Pemetrexed Pfizer, Pemetrexed Reig Jofre, Pemetrexed STADA, Pemetrexed Zentiva
ATC-koder

L01BA04

L01BA04
Substanser

pemetrexed, pemetrexeddinatrium-2,5-hydrat, pemetrexeddinatriumheptahy......

pemetrexed, pemetrexeddinatrium-2,5-hydrat, pemetrexeddinatriumheptahydrat, pemetrexedmonohydrat
Sammanfattning

Kvinnor har visats ha bättre effekt av pemetrexed-baserad kombinationsbehandling än män. Dock är kvinnor mer benägna att drabbas av illamående och kräkningar. Pemetrexedbehandling hos såväl kvinnor som män kan orsaka fosterskada och  ska undvikas till flickor och kvinnor som kan tänkas bli gravida om inte en effektiv preventivmetod ska användas.

Kvinnor har visats ha bättre effekt av pemetrexed-baserad kombinationsbehandling än män. Dock är kvinnor mer benägna att drabbas av illamående och kräkningar. Pemetrexedbehandling hos såväl kvinnor som män kan orsaka fosterskada och  ska undvikas till flickor och kvinnor som kan tänkas bli gravida om inte en effektiv preventivmetod ska användas.
Background

The incidence of lung cancer has decreased among men since the 1980s but has increased significantly among women, which reflects women's changing smoking habits. Now the proportion of smoking women is greater than the proportion of smoking men. In Sweden lung cancer made up 6.1% of all yearly cases of cancer, year 2016. The incidence was higher among women (6.8%, n=2067), compared to men (5.4%, n=1824) [1].

Generally, women mount stronger innate and adaptive immune responses than men [2]. Women with lung cancer have a more favorable survival compared to men [3]. The 5-year survival is 24 percent among women, and 17 percent among men in Sweden [1].

Since chemotherapeutic agents share some adverse effects, evaluation of a particular agent’s sex-related adverse effects during combination chemotherapy is complicated. Another factor that complicates the evaluation of chemotherapeutic treatments’ effect is a poorer prognosis in men compared to women of most oncologic diseases that affect both sexes [4, 5]. For instance, and related to this particular context, female sex is a favorable pr......

The incidence of lung cancer has decreased among men since the 1980s but has increased significantly among women, which reflects women's changing smoking habits. Now the proportion of smoking women is greater than the proportion of smoking men. In Sweden lung cancer made up 6.1% of all yearly cases of cancer, year 2016. The incidence was higher among women (6.8%, n=2067), compared to men (5.4%, n=1824) [1]. Generally, women mount stronger innate and adaptive immune responses than men [2]. Women with lung cancer have a more favorable survival compared to men [3]. The 5-year survival is 24 percent among women, and 17 percent among men in Sweden [1]. Since chemotherapeutic agents share some adverse effects, evaluation of a particular agent’s sex-related adverse effects during combination chemotherapy is complicated. Another factor that complicates the evaluation of chemotherapeutic treatments’ effect is a poorer prognosis in men compared to women of most oncologic diseases that affect both sexes [4, 5]. For instance, and related to this particular context, female sex is a favorable prognostic factor in non-small cell lung cancer (NSCLC) [6-10]. The increased risk of cancer for men has generally been explained by differences in exposure of carcinogenic factors such as smoking, alcohol consumption and exposure of harmful work-related substances [4, 5]. The belief that men might present later with more advanced cancer might in part explain the poorer prognosis seen in men [4]. # Pharmacokinetics and dosing No specific studies with relevant sex analysis regarding the pharmacokinetics of pemetrexed have been found. # Effects Subsequent therapies after first-line therapies in patients (624 men, 656 women) with advanced NSCLC were evaluated in a retrospective cohort analysis. Pemetrexed was the most profoundly administered agent in the first line therapy (22% as single agent, and 33% in a pemetrexed-based combination). Pemetrexed-based regimen as subsequent treatment was associated with overall survival (HR 1.26). Male sex was associated with shorter overall survival (HR 0.84) [11]. A review of clinical records of malignant pleural mesothelioma patients (281 men, 97 women; >70% treated with pemetrexed) found no association of sex with overall survival. Treatment was assessed in terms of chemotherapy, surgery, and radiotherapy [12]. A meta-analysis of six randomized controlled trials (n=2447) evaluated the efficacy and toxicity of maintenance therapy with bevacizumab plus pemetrexed versus bevacizumab/pemetrexed alone for stage IIIB/IV nonsquamous non-small cell lung cancer. Better progression free survival outcomes in the bevacizumab plus pemetrexed group occurred in females. Moreover, the overall survival for the bevacizumab plus pemetrexed group versus the bevacizumab/ pemetrexed group was more favourable in females [13]. A retrospective analysis of data from a phase III study of previously treated advanced NSCLC patients (411 men, 160 women) shows similar efficacy for pemetrexed and docetaxel. Women had a longer median survival compared to men (9.4 vs 7.2 months) [14]. # Adverse effects Female sex predicts a greater risk for acute emesis and poor antiemetic control [15]. A study used pooled data of 240 patients from two studies, namely a nationwide survey of CINV in Japan, and a prospective observational study, to investigate the incidence of chemotherapy-induced nausea and vomiting (CINV) among lung cancer patients (173 men, 67 women) undergoing either carboplatin plus pemetrexed, or carboplatin plus paclitaxel chemotherapy. Female sex was a risk factor for delayed nausea (OR 3.11) [16]. Data from two prospective observational studies, one the same nationwide survey mentioned above, and the other one a prospective, observational study were pooled. The incidence of delayed CINV in patients (173 men, 67 women) with NSCLC receiving carboplatin (+ pemetrexed or paclitaxel) was evaluated. Female sex was a risk factor for delayed vomiting (OR 3.372) [17]. # Reproductive health issues Pemetrexed like most other anti-cancer drugs is not compatible with pregnancy. Therefore, it is recommended that fertile  women use contraceptives during and for at least 6 months after use of pemetrexed. Men are advised to use effective contraceptive measures and are advised not to have children during treatment and up to 3 months after treatment [18]. Swedish users, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
Försäljning på recept

Läkemedel innehållande pemetrexed (ATC-kod L01BA04) används huvudsakligen på sjukhus och därför saknas könsuppdelade användningsdata [19].
Referenser
  1. Socialstyrelsen. Cancer i siffror 2018. Socialstyrelsen [www]. [updated 2018-06-10, cited 2020-10-01].
  2. Klein SL, Flanagan KL. Sex differences in immune responses. Nat Rev Immunol. 2016;16(10):626-38.
  3. Vera Regitz-Zagrosek. Sex and Gender Differences in Pharmacology. Springer-Verlag Berlin Heidelberg; 2012.
  4. Radkiewicz, C. Sex differences in cancer risk and survival. [dissertation]. Dept of Medical Epidemiology and Biostatistics: Karolinska Institutet; 2019.
  5. Edgren G, Liang L, Adami HO, Chang ET. Enigmatic sex disparities in cancer incidence. Eur J Epidemiol. 2012;27(3):187-96.
  6. de Perrot M, Licker M, Bouchardy C, Usel M, Robert J, Spiliopoulos A. Sex differences in presentation, management, and prognosis of patients with non-small cell lung carcinoma. J Thorac Cardiovasc Surg. 2000;119(1):21-6.
  7. Ferguson MK, Skosey C, Hoffman PC, Golomb HM. Sex-associated differences in presentation and survival in patients with lung cancer. J Clin Oncol. 1990;8(8):1402-7.
  8. Singh S, Parulekar W, Murray N, Feld R, Evans WK, Tu D et al. Influence of sex on toxicity and treatment outcome in small-cell lung cancer. J Clin Oncol. 2005;23(4):850-6.
  9. Visbal AL, Williams BA, Nichols FC, Marks RS, Jett JR, Aubry MC et al. Gender differences in non-small-cell lung cancer survival: an analysis of 4,618 patients diagnosed between 1997 and 2002. Ann Thorac Surg. 2004;78(1):209-15; discussion 215.
  10. Hsu LH, Chu NM, Liu CC, Tsai SY, You DL, Ko JS et al. Sex-associated differences in non-small cell lung cancer in the new era: is gender an independent prognostic factor?. Lung Cancer. 2009;66(2):262-7.
  11. Afanasjeva J, Hui RL, Spence MM, Chang J, Schottinger JE, Millares M et al. Identifying Subsequent Therapies in Patients with Advanced Non-Small Cell Lung Cancer and Factors Associated with Overall Survival. Pharmacotherapy. 2016;36(10):1065-1074.
  12. Mencoboni M, Filiberti RA, Taveggia P, Grosso F, Pasello G, Del Corso L et al. Clinical Features and Treatment Outcome of Malignant Pleural Mesothelioma. Oncol Res Treat. 2017;40(6):364-369.
  13. Liu M, Luo N, Fang Z, Liu Q, Yi F, Wei Y et al. The efficacy and toxicity of maintenance therapy with bevacizumab plus pemetrexed versus bevacizumab/pemetrexed alone for stage IIIB/IV nonsquamous non-small cell lung cancer: A meta-analysis of randomized controlled trials. J Clin Pharm Ther. 2022;47(2):157-167.
  14. Weiss GJ, Rosell R, Fossella F, Perry M, Stahel R, Barata F et al. The impact of induction chemotherapy on the outcome of second-line therapy with pemetrexed or docetaxel in patients with advanced non-small-cell lung cancer. Ann Oncol. 2007;18(3):453-60.
  15. Gralla RJ, Osoba D, Kris MG, Kirkbride P, Hesketh PJ, Chinnery LW et al. Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines American Society of Clinical Oncology. J Clin Oncol. 1999;17(9):2971-94.
  16. Hayashi T, Shimokawa M, Matsuo K, Iihara H, Kawada K, Nakano T et al. Chemotherapy-induced nausea and vomiting (CINV) with carboplatin plus pemetrexed or carboplatin plus paclitaxel in patients with lung cancer: a propensity score-matched analysis. BMC Cancer. 2021;21(1):74.
  17. Shimokawa M, Haratake N, Takada K, Toyokawa G, Takamori S, Mizuki F et al. Combination Antiemetic Therapy for Chemotherapy-Induced Nausea and Vomiting in Patients with NSCLC Receiving Carboplatin-Based Chemotherapy. Cancer Manag Res. 2022;14:2673-2680.
  18. Pemetrexed Accord (pemetrexed). Summary of Product Characteristics. European Medicines Agency [updated 2022-08-01, cited 2023-04-04]
  19. Conise (INSIKT). Kalmar: eHälsomyndigheten. 2018 [cited 2021-11-18.]
Uppdaterat

Litteratursökningsdatum: 4/4/2023

Litteratursökningsdatum: 4/4/2023