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 efficacy.

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 anti-folate medication that blocks the enzymes required for DNA replication and cell division.

Alimta Information

Chemotherapy drug, Alimta
  • Other Names: Pemetrexed
  • Manufactured by: Eli Lilly and Company
  • FDA-approved: Yes
  • Used or Tested in: Lung cancer and pleural mesothelioma

Approved by the Food and Drug Administration (FDA) in 2004, Alimta is the only medication specifically approved for the treatment of malignant pleural mesothelioma.

Historically, mesothelioma has been one of the most difficult forms of asbestos cancer to treat. Though doctors have been prescribing chemotherapy for decades, few chemotherapeutic agents have had much effect on the aggressive disease.

Among recently approved mesothelioma medications, Alimta 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 and the FDA’s only approved standard-of-care regimen for the asbestos-related cancer.

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 nonchemotherapy patients.

A separate multicenter, randomized trial showed patients taking the combination survived 13.3 months, compared to 10 months for patients receiving only cisplatin.

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Clinical Trials Continue to Prove Alimta’s Efficacy

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.
  • 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 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.

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Alimta Dosage and Treatments

The recommended dose of Alimta is 500 mg 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 — if the first-line chemotherapy wasn’t effective — or as a maintenance treatment to prolong remission.

Common Side Effects of Alimta

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:

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When combined with cisplatin, more than 20 percent of patients experienced vomiting, low or reduced white blood cell count, anemia (deficiency of red blood cells), sores and swelling in the mouth and throat, a low blood platelet count (thrombocytopenia) and constipation.

Diagram showing the different side effects of Alimta and cisplatin

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 and 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.

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Karen Selby, RN

Karen Selby joined 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.

  1. Ettinger, D. et al. (2016). NCCN Guidelines Insights: Malignant Pleural Mesothelioma, Version 3.2016. Retrieved from
  2. (2016, January 15). Methoxyamine, Cisplatin, and Pemetrexed Disodium in Treating Patients With Advanced Solid Tumors or Mesothelioma That Cannot Be Removed by Surgery or Mesothelioma That Is Refractory to Cisplatin and Pemetrexed. Retrieved from
  3. National Cancer Institute. (2014, September 17). Drugs Approved for Malignant Mesothelioma. Retrieved from
  4. U.S. National Library of Medicine. (2017, March 3). LABEL: ALIMTA- pemetrexed disodium injection, powder, lyophilized, for solution. Retrieved from

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