Effects of Folic Acid and Vitamin B12 Supplementation on the Efficacy and Toxicity of Pemetrexed in the Management of Advanced Stage Non-Squamous Non-Small Cell Lung Cancer

Abstract

Pemetrexed (PMT) is a multi-target antifolate that has been confirmed for the treatment of lung cancer. It has significantly boosted the survival rate of patients with non-squamous non-small-cell lung cancer. Multiple Phase II clinical trials have demonstrated that pemetrexed is an effective monotherapy for a range of solid tumors, including colorectal, breast, neck, and head malignancies. Methods for consolidating pemetrexed with other chemotherapeutics and novel molecularly targeted drugs are currently under investigation. Pemetrexed is currently recommended for first-line dose management with platinum chemotherapies, second-line monotherapy drugs, and, in modern chemotherapy protocols, as continuation therapy following first-line therapy. Vitamin B12 (VB12) and folic acid (FA) supplements can aid to minimize the cytotoxicity of pemetrexed. FA/VB12 has been suggested to have an antagonistic effect on pemetrexed's efficacy. Patients who accept FA/VB12 have a higher tolerance for PMT and a longer lifespan. In this study, the pharmacodynamics, pharmacokinetics, and toxicity of pemetrexed were studied, as well as the implications of FA/VB12 as a co-medication with pemetrexed-based chemotherapy.