Pemetrexed, marketed by Eli Lilly and Company under the brand name Alimta, is the standard chemotherapy drug for treating mesothelioma. Doctors often combine it with platinum-based drugs such as cisplatin or carboplatin to increase its effectiveness.
Doctors have prescribed chemotherapy to treat mesothelioma for decades, but few chemotherapeutic agents have had much effect on the aggressive cancer.
Alimta stands out as having the most promise in prolonging the life of mesothelioma patients, as well as improving their quality of life. It is a multitargeted antifolate medication that blocks the enzymes required for DNA replication and cell division.
In 2004, the U.S. Food and Drug Administration (FDA) approved Alimta in combination with cisplatin for the treatment of malignant pleural mesothelioma. The approval was based on the positive results of a phase III clinical trial led by mesothelioma expert Dr. Hedy Kindler.
Historically, mesothelioma is difficult to treat. Though doctors have been prescribing chemotherapy for decades, few chemotherapeutic agents have had much effect on the aggressive disease.
Among commonly used mesothelioma medications, Alimta in combination with cisplatin stands out as having the most promise in prolonging the life of mesothelioma patients, as well as improving their quality of life.
The long-standing combination of Alimta and cisplatin is considered the most effective chemotherapy treatment for pleural mesothelioma patients who are not candidates for surgery. This is the FDA’s only approved standard-of-care regimen for mesothelioma.
Alimta and cisplatin comprised the most commonly prescribed regimen for first-line chemotherapy in a 2016 study that linked data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database with Medicare claims data. The median survival for patients who received the drug combination was one year, compared to just four months for non-chemotherapy patients.
A separate multicenter, randomized trial showed patients taking the combination survived 13.3 months, compared to 10 months for patients receiving only cisplatin.
Eli Lilly and Company
Pemetrexed disodium heptahydrate
Lithium, methotrexate, probenecid, NSAIDs, antiviral medicines, intravenous antibiotics, ulcerative colitis medicines, organ transplant rejection medicines
Decreased renal function, bone marrow suppression, fetal toxicity, need for patients to supplement with folate and B12
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Researchers around the world are searching for more effective drug combinations to combat mesothelioma. Alimta is commonly used as the baseline chemotherapy drug for these combinations.
Some notable clinical trials involving Alimta include:
Testing the combination of Alimta, cisplatin and methoxyamine — a small molecule inhibitor drug — in patients whose mesothelioma has progressed after previous chemotherapy. Methoxyamine boosts the effectiveness of chemotherapy.
A groundbreaking trial at the Mesothelioma Treatment Center at the Baylor College of Medicine Lung Institute is combining cytoreductive surgery with a hyperthermic, intraoperative chemotherapy lavage of cisplatin and Alimta.
A phase II trial combining the immunotherapy drug ONCOS-102 with Alimta and cisplatin. ONCOS-102 is engineered to induce systemic, anti-tumor responses.
In 2016, the National Comprehensive Cancer Network (NCCN) changed its first-line treatment recommendation for unresectable pleural mesothelioma to include the monoclonal antibody bevacizumab, an anti-angiogenesis agent, with the Alimta and cisplatin combination.
The Alimta and cisplatin combo has been the standard-of-care regimen for mesothelioma since 2004, but the FDA could soon adopt the addition of bevacizumab following the NCCN’s recommendation.
A 2017 study showed that Alimta and cisplatin are also effective in controlling peritoneal mesothelioma. For peritoneal patients who don’t qualify for cytoreductive surgery, Alimta and pemetrexed may be administered systemically to extend survival and reduce symptoms.Learn More About Mesothelioma Clinical Trials
The recommended dose of Alimta is 500 mg/m-2 administered through injection into an IV (intravenous) line. It only takes about 10 minutes to administer each dose.
Cisplatin is typically infused over two hours beginning approximately 30 minutes after the Alimta dose. This cycle is repeated every three weeks, and it is up to the mesothelioma specialist to determine how many cycles a patient receives.
Alimta may be used by itself as a second-line therapy — after relapse — or as a maintenance treatment to prolong remission.
The side effects of Alimta are usually mild to moderate for most patients with pleural mesothelioma cancer. Some patients may experience extreme side effects and a doctor should be informed immediately if a reaction becomes a serious problem.
In clinical trials, the most common side effects of Alimta as a single-agent treatment include:
When combined with cisplatin, more than 20 percent of patients experience:
Mesothelioma patients should avoid being near people who have colds, the flu or other signs of illness.
Be sure to contact your doctor right away if you develop signs of infection. Tell your doctor before receiving Alimta if you are taking an NSAID such as ibuprofen, naproxen, indomethacin or ketoprofen.
Patients with kidney disease, liver disease, a weak immune system or excess fluid in the space around their lungs, liver or other internal organs should consult their doctor and carefully weigh the benefits of taking Alimta with potential risks.
Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators. Read More