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Alimta is a chemotherapy drug specifically approved for use in patients with mesothelioma. Alimta is the brand name drug made by Eli Lilly and company, and the generic name of the drug is pemetrexed. The U.S. Food and Drug Administration (FDA) approved Alimta for use in certain patients with non-small cell lung cancer and for those with mesothelioma. For the latter, it is typically combined with cisplatin, a different chemotherapy drug.

While Alimta has proven to be a promising new medication for mesothelioma, extending patient’s lives and making quality of life better, it does cause side effects. These include fatigue and nausea most commonly. When combined with the generic chemotherapy drug cisplatin, Alimta is considered to be one of the most effective treatments for pleural mesothelioma, and it is one of the most commonly prescribed.

What is Alimta?

Alimta, or pemetrexed, is a chemotherapeutic drug, which means that it is intended to treat cancer by killing cancer cells. Alimta is administered as an injection, which sends the drug through the blood stream and circulates it throughout the body. It is typically given every three weeks. Pemetrexed is a type of drug called an antifolate antineoplastic agent. It works by blocking three enzymes that are essential for the cancer cells to make DNA and RNA. Without these molecules the cancer cells cannot grow and divide, and will not survive.

The FDA approved Alimta in 2004. It is specifically approved to treat patients with non-small cell lung cancer in combination with cisplatin. It is also approved for treatment in non-small cell lung cancer patients who have already had a single-agent cycle of chemotherapy and for maintenance treatment. Combined with cisplatin, it is approved for treatment of malignant mesothelioma.

Side Effects and Their Management

There are a lot of potential side effects of being administered Alimta because, like other chemotherapy drugs, it does not specifically target cancer cells. The drug circulates throughout the body and may harm healthy cells as well as cancer cells. This results in side effects. The most common side effects of Alimta are fatigue, nausea, and anorexia. With cisplatin, other common side effects are anemia, vomiting, lowered white blood cell count and platelet count, mouth sores, sore throat, and constipation.

Side effects may be minimized by taking supplemental drugs or vitamins. For instance, supplementing with folic acid before and after treatment is recommended. Pemetrexed is an antifolate, which means it disrupts cellular processes that depend on folic acid. To help maintain the health of non-cancer cells, extra folic acid is helpful, and this in turn may prevent or relieve some of the side effects of using the drug. Patients may also take vitamin B12 to reduce the effects of anemia and fatigue. Corticosteroids may also help with some of the side effects.

NCCN Guidelines

The National Comprehensive Cancer Network (NCCN) sets guidelines, called the NCCN Clinical Practice Guidelines in Oncology, which are evidence-based guidelines for treating different types of cancer. The NCCN is a non-profit group of 27 cancer centers that come together to collaborate on research, education, and projects like the guidelines.

Since Alimta was first approved in 2004, it has become one of the most commonly prescribed drugs for mesothelioma, and it is part of the NCCN guidelines. The panel of experts recommends that Alimta combined with cisplatin be used to treat mesothelioma. The panel also recommends that a new chemotherapy drug be added to make a three part combination of treatment: Alimta, cisplatin, and bevacizumab, but only in patients who are good candidates for the newer drug.

The NCCN guidelines demonstrate how effective Alimta has been in treating patients with mesothelioma. There are few effective treatments for this cancer, but for the last ten years, Alimta with cisplatin has been an important frontline treatment that has extended the lives of patients beyond what was expected. It has also been shown to give patients a better quality of life.

Alimta Efficacy

Clinical trials have proven time and again that Alimta is effective in extending the lives of patients with mesothelioma. In one trial for example, patients with mesothelioma were randomized, with 222 patients receiving only cisplatin and 226 receiving both cisplatin and Alimta. The latter group survived an average of 12 months after treatment, while those receiving only cisplatin survived an average of 9 months.

In another trial, patients with pleural mesothelioma underwent trimodal therapy with cisplatin/Alimta chemotherapy, followed by the surgical procedure called an extrapleural pneumonectomy, and finally were given radiation therapy. Not all patients were able to complete all three stages of treatment. Among those who did, survival time was 29 months. Among those who could not complete all of the treatments, survival time was only 17 months.

Ongoing Clinical Trials with Alimta

Although it has been on the market for more than ten years, clinical trials are continuing to test the effectiveness of Alimta and how it can be combined with other therapies to better help mesothelioma patients. These include a combination of Alimta, cisplatin, and a third drug called methoxyamine used in patients whose previous chemotherapy attempts were unsuccessful.

Another ongoing trial with Alimta is combining it with an immunotherapy drug called ONCOS-102. This new drug that is just being tested in clinical trials is supposed to help the immune system recognize tumors and cancer cells so that it will attack and kill them, supporting the action of Alimta. In yet another clinical trial, researchers are combining cytoreductive surgery for peritoneal mesothelioma patients with a hyperthermic wash of cisplatin and Alimta.

Alimta is a chemotherapy drug that has been proving to help patients with malignant mesothelioma for more than a decade. Although it causes side effects, these can be managed in most patients and for most the risks are outweighed by the benefits. This drug is giving mesothelioma patients, who normally have so few options for treatment, the ability to live longer than they expected and to do so with a better quality of life. Now, more research is expanding on the use of Alimta and finding new ways that it can be used to help patients who otherwise have little hope in for effective treatment.

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