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Alimta is a chemotherapy drug specifically approved for treatment of mesothelioma.  Alimta, manufactured by the pharmaceutical company Eli Lilly, is the trade name for the generic drug Pemetrexed. The U.S. Food and Drug Administration (FDA) approved Alimta for use in certain patients with mesothelioma or non-small cell lung cancer. In cases of mesothelioma, Alimta is  typically combined with cisplatin, another chemotherapy drug.

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

What is Alimta?

Alimta is a chemotherapeutic drug. Chemotherapy drugs treat cancer by targeting and killing cancer cells. Alimta is administered as an injection or as an infusion into the vein. This method of administration sends the drug through the blood stream circulating it through 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 are essential for cancer cells to make DNA and RNA. Without these molecules, cancer cells cannot grow and divide, causing them to die.

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

Side Effects and Their Management

Alimta has several potential side effects.  Like other chemotherapy drugs, it does not specifically target cancer cells. Instead, the drug circulates through the body, possibly harming healthy cells as it kills cancer cells. The harming of healthy cells is what causes the drug’s side effects.  Alimta most commonly causes fatigue, nausea, and anorexia. With cisplatin, other common side effects include anemia, vomiting, lowered white blood cell and platelet counts, mouth sores, sore throat, and constipation.

Supplemental drugs or vitamins can help minimize Alimta’s side effects. Specifically taking folic acid and vitamin B12 before and after treatment is recommended since Alimta is an antifolate. This means it disrupts cellular processes that depend on folic acid. To help maintain the health of non-cancer cells, extra folic acid and B12 is helpful, and could prevent or relieve some of the drug’s side effects. Patients may also take vitamin B12 to reduce the effects of anemia and fatigue. Corticosteroids may also help with side effects.

NCCN Guidelines

The National Comprehensive Cancer Network (NCCN) sets guidelines, called the NCCN Clinical Practice Guidelines in Oncology. These are evidence-based guidelines for treating different types of cancer. The NCCN is a non-profit group of 27 cancer centers that 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 is part of the NCCN guidelines. The NCCN panel of experts recommends that Alimta combined with cisplatin for treatment of mesothelioma. The panel also recommended a new chemotherapy drug be added to create a three part combination of treatment: Alimta, cisplatin, and bevacizumab. However this triple treatment is only recommended for patients who are good candidates for the newer drug.

The NCCN guidelines demonstrate how effective Alimta has been for mesothelioma treatment. 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. For example, one trial included 222 patients receiving only cisplatin and 226 receiving both cisplatin and Alimta. The group receiving both drugs lived 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 extrapleural pneumonectomy. Finally, these patients were given radiation therapy. Some patients were unable to complete all three stages of treatment. However, for those patients who did receive all three stages, survival time was 29 months. For those unable to complete treatment, average survival time was only 17 months.

Ongoing Clinical Trials with Alimta

Clinical trials are continuing to test the effectiveness of Alimta, in spite of the fact it has been on the market for more than a decade. Clinical trials continue in attempts to determine how the drug can be used to treat 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 combines Alimta with an immunotherapy drug called ONCOS-102. This new drug is just being tested in clinical trials to help the immune system recognize tumors and cancer cells. The hope is that these drugs will assist Alimta in attacking and killing cancer cells specifically. 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 proving to help patients with malignant mesothelioma for more than a decade. Although it has several side effects, these can be effectively managed in most patients. For most, the benefits far outweigh the risks. This drug is giving mesothelioma patients with few options for treatment the ability to live longer, better lives. Currently, more research is expanding on the use of Alimta, constantly discovering new ways it can be used to help patients who otherwise have little hope for effective treatment.

Page Edited by Dave Foster

Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available. Connect with Patient Advocate Dave Foster

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