Lung Adenocarcinoma treatment - Maintenance with Osimertinib(oral) + Pemetrexed(IV)

Hi I have received one treatment of pemetrexed and carbopletin my next treatment is now delayed white low blood count last week and I now have a rash so another delay Ct scan booked for next week then appointment with my oncologist week after then more bloods with treatment resuming same week side effects were sore head nausea fatigue and rash after the one treatment hope everything works out for you I have stage 4 non small cell carcinoma diagnosed December 30 last year xx

My husband was diagnosed stage a year ago, had keytruda from April to Sept first scan showed stable & lymph node shrinkage, he had awful side effects. The 2nd scan showed growth in the lung to 71mm, so keytruda was stopped & he had 4 cycles of carboplatin/premextred & no side effects at all & was due to start premextred maintenance in Jan 2026, but kidney function level flew up from 75 to 111, so delayed treatment. So far hes only had one prem maintenance due to this kidney function issue. But the 4 cycles of carb/prem & 1 prem maintenance as shown an amazing response, 71mm on lung to 29mm, hip was 28 down to 15mm & more shrinkage on last scan. He hasnt had any side effects at all, no urine issues, asymptomatic of stage 4 lung cancer. Hes back to Marsden tomoz for bloods & fingers crossed he can restart maintenance. Last weeks creatitine level was 120 & it needs to be below 110.

Hi Janiee,

Thank you for your message. Emollients and a mild steroid ointment might help with your rash. discuss with your Oncologist. 

Hope your side effects will get better and wish you a speedy improvement.

Hi, Thank you so much for sharing your husband's experience, that's very helpful. Hope he will be able to complete treatment without any significant issues. 

Did they tell you that Pemetrexed can be restarted later once your kidney functions are okay? 

Hi. Yes it can be restarted, but every time he as it, his kidney function level jumps. None of it make sense TBH, as when he was having both carb/prem not a problem. He finished his 4th & final carb/prem on Dec 12th, creatitine 75 & had been in that region throughout. He went back to start maint prem on Jan 6th & it was 111, which red flagged a jump. So postponed & eventually had first prem maint on Jan 20th. Three wks later his creatitine level went to 133 so delayed another 2 wks, which was last wk & had come down to 120.

Hes drinking 2 litres of water per day, plus saline flushes. So if in normal range today, he can restart. But if each time he as it, the creatitine level spikes, then this will really become a problem for maintenance treatment. Its becoming stressful, as his response to treatment as been amazing. The Marsden have scanned his bladder, kidneys etc & all clear, he as no UTI's, so its defo reaction to premextred. Not sure what will happen today if creatitine hasnt dropped, all a bit stressful. We're just glad his scans have shown a huge shrinkage, but need to get back onto a treatment plan, as hes been in limbo since January back & forth only managing to have one treatment. Just hoping all goes ok today.