Pemetrexed is marketed by Eli Lilly and Company under the brand name Alimta. It is the most effective chemotherapy drug for mesothelioma. Doctors often combine Alimta with platinum-based drugs such as cisplatin and carboplatin to increase its effectiveness.
Written by Karen Selby, RN Edited By Walter Pacheco Medically Reviewed By Dr. Arkadiusz Z. Dudek
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What Is Alimta?
Alimta is approved by the U.S. Food and Drug Administration to treat nonsquamous non-small cell lung cancer and malignant mesothelioma.
Doctors have prescribed chemotherapy to treat mesothelioma cancer for decades. Few chemotherapy drugs have had as much of an effect as Alimta.
Alimta stands out as having the most promise in prolonging mesothelioma life expectancy. It also improves quality of life by reducing breathing difficulty and chest pain.
It is a medication that blocks DNA replication and cell division. This action causes mesothelioma cells to die rather than grow.
When Was Alimta Approved for Mesothelioma?
The first phase I study of Alimta for mesothelioma was published in 1999. It combined Alimta and cisplatin for mesothelioma and proved the effectiveness of these drugs against the cancer.
In 2004, the 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. Nicholas J. Vogelzang.
This study inspired other mesothelioma specialists, such as Dr. Hedy Kindler, to further study Alimta in combination with cisplatin and other mesothelioma drugs.
How Alimta Attacks Mesothelioma
Alimta works by stopping cancer cells from rapidly dividing. It blocks the production of folate — a vitamin involved in cell division — and stops the division and replication of mesothelioma cells.
This action causes the cancer cells to die instead of grow.
Alimta belongs to a class of drugs called antimetabolites. Because it blocks folate, it is considered an antifolate antimetabolite.
Alimta and Cisplatin for Mesothelioma
Alimta and cisplatin are combined to improve survival. This drug combination is considered the most effective treatment for pleural mesothelioma patients who are not candidates for surgery.
This is the only FDA-approved chemotherapy regimen for mesothelioma.
Alimta and cisplatin are the most commonly prescribed drugs for first-line mesothelioma chemotherapy. They help mesothelioma patients live around one year. Without them, most patients survive an average of four months.
One clinical trial showed that patients taking the combination survived 13.3 months. Patients who only received cisplatin lived 10 months.
|First Mesothelioma Clinical Trial||1999|
|Types of Mesothelioma Treated||Pleural and peritoneal mesothelioma|
|Stages of Mesothelioma||Stages 1 through 4|
|Commonly Paired with||Cisplatin and carboplatin|
|Ongoing Trials||Pemetrexed Disodium/Observation in Treating Patients with Malignant Pleural Mesothelioma Without Progressive Disease After 1st Line Chemotherapy|
|Medical Studies||Study of Cytoreductive Surgery and Hyperthermic Intraoperative Chemotherapy with Pemetrexed and Cisplatin for Malignant Pleural Mesotheliomas|
Mesothelioma Chemotherapy and Alimta Research
Clinical trials are researching more effective drug combinations to treat mesothelioma. Alimta is used as the baseline chemotherapy drug for these combinations.
Promising clinical trials involving Alimta include:
- A 2016 phase III clinical trial added bevacizumab to cisplatin and Alimta with a positive impact on overall survival. Pleural mesothelioma patients who received all three drugs lived an average of 18.8 months compared to 16.1 months among those who only received cisplatin and Alimta. Bevacizumab is an anti-angiogenesis drug. This kind of drug blocks blood supplies and keeps mesothelioma from spreading.
- In a study of Tumor Treating Fields (TTFields) with Alimta and cisplatin or carboplatin, a median survival of 18.2 months was demonstrated. This study led to the approval of TTFields for treatment of mesothelioma.
- In a trial studying the combination of cisplatin and Alimta with the immune checkpoint inhibitor durvalumab, 57% of patients had no mesothelioma progression at six months. This combination is now being studied in a large phase III trial.
In 2016, the National Comprehensive Cancer Network changed its first-line treatment recommendation for inoperable pleural mesothelioma.
NCCN added the monoclonal antibody bevacizumab to the Alimta and cisplatin combination. Bevacizumab is an anti-angiogenesis drug. This kind of drug blocks mesothelioma from spreading.
The Alimta and cisplatin combo has been the standard-of-care regimen for mesothelioma since 2004. The FDA may approve bevacizumab following the NCCN’s recommendation.
Alimta for Peritoneal Mesothelioma
A 2017 study published in Expert Review of Anticancer Therapy showed Alimta and cisplatin are also effective in controlling peritoneal mesothelioma. For peritoneal patients who don’t qualify for surgery, Alimta and cisplatin may be administered systemically to extend survival and reduce symptoms.
Alimta Dosage and Treatments
The recommended dose of Alimta is 500 mg/m². It is administered through injection into an IV line. It only takes about 10 minutes to administer each dose.
Cisplatin is typically infused over two hours. Infusion begins approximately 30 minutes after the Alimta dose. This cycle is repeated every three weeks. 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 when the cancer relapses. It is also used as a maintenance treatment to prolong remission.
Alimta Side Effects
The side effects of Alimta are usually mild to moderate for most patients. Some patients may experience extreme side effects. A doctor should be informed immediately if a reaction becomes a serious problem.
The most common side effects of Alimta as a single-agent treatment include:
When combined with cisplatin, more than 20% of patients experience:
- Low or reduced white blood cell count
- Anemia (deficiency of red blood cells)
- Sores and swelling in the mouth and throat
- Low blood platelet count (thrombocytopenia)
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 to avoid a drug interaction. NSAIDs include ibuprofen, naproxen, indomethacin or ketoprofen.
Patients with certain conditions should consult their doctor about the risks and benefits of taking Alimta. Anyone with kidney disease, liver disease, a weak immune system or excess fluid in the space around their lungs, liver or other internal organs should take precaution.
Alimta changed the landscape of mesothelioma treatment in the early 2000s. Prior to its FDA approval, mesothelioma patients had few options to extend their survival.
Researchers continue to test Alimta in combination with new drugs. Their goal is to find the most effective ways to use it to improve the lives of people with mesothelioma.