01. What Is Alimta?
What Is Alimta (Pemetrexed)?
Alimta®, known generically as pemetrexed, is a chemotherapy drug. Specifically, Alimta is a type of chemotherapy called an antifolate, which can kill or slow the growth of cancer cells. In 2004, Alimta received Food and Drug Administration (FDA) approval as part of a combination therapy for malignant pleural mesothelioma patients. It was the first FDA-approved chemotherapy drug for mesothelioma. The drug is also FDA-approved for non-small cell lung cancer.
For pleural mesothelioma, Alimta is only approved for use in conjunction with cisplatin, a platinum-based chemotherapy drug. The drug has also been tested in combination with immunotherapy drugs, such as Keytruda® (pembrolizumab) for lung cancer patients. However, research is limited for mesothelioma patients.
Patients who are eligible for pemetrexed also have an alternative to Alimta. Pemfexy® (pemetrexed injection) is a newer brand of pemetrexed and is widely available abroad. It is manufactured as a ready-to-dilute solution, whereas Alimta is manufactured as a powder and is mixed into an intravenous solution.
Alimta (Pemetrexed) Quick Facts
- Generic names: Pemetrexed, pemetrexed disodium
- Brand names: Alimta, Pemfexy
- Administration: Intravenous
- Often combined with: Alimta is often combined with cisplatin or carboplatin as part of a multimodal therapy.
- Types of mesothelioma treated: Pleural mesothelioma, peritoneal mesothelioma
- Manufacturer: Alimta is manufactured by Eli Lilly and Company, Pemfexy is manufactured by Eagle Pharmaceuticals
- FDA approval: Alimta and Pemfexy are both approved as a first-line treatment for unresectable pleural mesothelioma and non-small cell lung cancer in conjunction with cisplatin. Both drugs are approved as second-line treatment for non-small cell lung cancer.
02. Alimta and Mesothelioma
How Does Alimta (Pemetrexed) Treat Mesothelioma?
Alimta is combined with cisplatin to treat mesothelioma. Alimta works by interfering with several enzymes that are necessary for DNA replication. This in turn can slow the growth of mesothelioma cancer cells and/or kill them.
Specifically, Alimta is categorized as an antifolate. These drugs work by preventing cells from using folic acid, which assists in the production of DNA. Alimta ️is a systemic chemotherapy drug. This means patients are given Alimta through an IV, allowing the drug to circulate through patients’ bloodstreams. Patients may receive multiple cycles of the chemotherapy, depending on their needs.
Alimta with cisplatin is approved for pleural mesothelioma. The combination has also been tested in peritoneal mesothelioma but has not received FDA approval.
Alimta (Pemetrexed) and Cisplatin for Pleural Mesothelioma
In 2004, the FDA approved Alimta ️and cisplatin for the treatment of unresectable pleural mesothelioma. Cisplatin is another chemotherapy drug that works to stop tumor growth. Currently, this combination is the only approved chemotherapy for use against mesothelioma.
This regimen may be used as a first or second-line treatment. As a first-line therapy, one study found Alimta ️and cisplatin may extend survival to about one year. Patients taking cisplatin on its own had a median survival of about nine months.
Some patients taking Alimta ️and cisplatin have experienced extended survival from receiving the duo as a second-line treatment. Second-line treatments are used after an initial treatment to further treat the disease. One study found second-line Alimta ️and cisplatin extended survival to 15.3 months.
As a result, this combination can be an effective option to extend survival for pleural mesothelioma patients who are not eligible for surgery.
Alimta (Pemetrexed) for Peritoneal Mesothelioma
Alimta has also been studied for use against peritoneal mesothelioma. However, it is not a particularly useful treatment against this form of mesothelioma. Researchers found Alimta and cisplatin did not sufficiently extend peritoneal patient life expectancy.
Alimta (Pemetrexed) for Asbestos-Related Lung Cancer
Alimta ️is also approved for treating patients with non-small cell lung cancer. The FDA has approved three uses of the chemotherapy drug for non-small cell lung cancer. Research has shown asbestos can cause any type of lung cancer.
|FDA-Approved Alimta Regimen||Median Survival for Lung Cancer Patients*|
|Initial treatment, combined with cisplatin||10.3 months|
|Maintenance treatment, after four cycles of platinum-based chemotherapy for patients whose disease has not progressed||13.4 months|
|Single-agent treatment, after prior chemotherapy||8.3 months|
*Source: Eli Lilly and Company. ALIMTA (pemetrexed disodium) Injection.
Alimta. has also been used in combination with Keytruda for patients with advanced nonsquamous non-small cell lung cancer (NSCLC). One study found positive results for Alimta combined with Keytruda and a platinum-based chemotherapy, such as cisplatin. In this study, researchers found 48% of patients experienced a reduction in tumor size when taking all three drugs. Comparatively, 19% of patients saw their tumors shrink when taking Alimta and platinum chemotherapy alone.
03. What to Expect
What to Expect During Treatment
For malignant pleural mesothelioma, Alimta is given in 21-day cycles. In the seven-day week before treatment begins, patients will receive:
- At least five daily doses of folic acid
- One intramuscular injection of vitamin B12
- A corticosteroid (dexamethasone) the day before, the day of and the day after treatment
These supplements help reduce the incidence of side effects for patients.
On the first day of the 21-day cycle, patients will receive the intravenous Alimta and cisplatin infusions. These infusions are given in a hospital or cancer center. The treatment combination is given as infusions in several stages:
- Patient receives 500 mg/m2 of pemetrexed infusion over 10 minutes.
- Patient rests for 30 minutes between the pemetrexed infusion and cisplatin infusion.
- Patient receives 75 mg/m2 of cisplatin infusion over 2 hours.
The dosages are calculated using the surface area of the patient’s skin, which is why it is measured per square meter.
The patients spend the following days of the cycle resting and recovering.
Cycles can be repeated as many times as recommended by a doctor. In a clinical study, more than half of pleural mesothelioma patients received at least six cycles of treatment.
Preparing for Your Appointment
Patients taking Alimta will receive several supplements in the form of injections and tablets leading up the infusion. These can help reduce the instances of adverse events from the treatment. In addition to taking these supplements, patients can also take other steps to prepare.
Patients may feel nervous before their chemotherapy appointments. Common tips for preparing for chemotherapy include:
- Notify your employer of your appointment. Beyond the day of treatment, prepare your employer for the possibility of needing further time to recuperate during the 21-day cycle.
- Tell your friends and family about your appointments and follow-up care needs.
- Arrange for transport to and from the appointment.
- Clear your schedule the day of the appointment.
- Stock up on easy-to-prepare food to eat during treatment and readily available fluids.
Mesothelioma patients should also speak with their care team about what to expect and how to manage.
Managing Treatment and Follow-Up Care
Chemotherapy can be physically taxing and leave patients tired. In the days after an infusion, a patient’s biggest responsibility is to rest and let the chemotherapy drugs do their work.
In most cases, patients will receive several cycles of Alimta and cisplatin. Patients can speak with their doctors about arranging follow-up visits to measure progress and manage side effects.
04. Benefits of Alimta
Alimta (Pemetrexed) Benefits
Alimta with cisplatin can be beneficial as part of a pleural mesothelioma treatment plan.
It may be most beneficial as a second-line treatment for patients who are not eligible for surgical options. This treatment provides these patients with hope for improving survival.
Alimta patients do experience some chemotherapy side effects. However, the common chemotherapy side effect of hair loss is relatively rare with Alimta, which may be a benefit to some patients.
Research and clinical trials are ongoing to test Alimta in combination with other treatments, including immunotherapy and Tumor Treating Fields (TTFields).
05. Side Effects of Alimta
Alimta (Pemetrexed) Side Effects
As with other chemotherapy drugs, patients receiving Alimta may face some side effects. These can differ based on how the patient reacts to the treatment. Patients may also experience different side effects depending on if pemetrexed is given alone or combined with other therapies.
The approved combination of Alimta and cisplatin is generally well-tolerated. However, it may cause side effects such as fatigue, loss of appetite and nausea. Like many other chemotherapy drugs, there is also a risk of the patient sustaining hair loss or thinning. However, the risk of hair loss is low for patients taking Alimta.
A mesothelioma doctor will discuss these side effects with the patient and their care team before beginning treatment. They will also help with managing any side effects that arise.
Potential Side Effects of Alimta (Pemetrexed) and Cisplatin
- Hair loss
- Loss of appetite
- Low blood cell counts (red, white and platelets)
- Mouth, throat or lip sores
- Upset stomach
Managing Side Effects
Mesothelioma patients may be given supplements during and after treatment to help prevent and manage side effects of Alimta. These supplements include:
- One intramuscular injection of vitamin B12 the week before treatment with Alimta begins. This helps to reduce the incidence of side effects from Alimta.
- A corticosteroid (dexamethasone) the day before, the day of and the day after Alimta is administered. This treatment helps to reduce the incidence and severity of skin rashes.
Patients should consult their doctor before taking over-the-counter medications. Interactions may occur between common nonsteroidal anti-inflammatory drugs (NSAIDs) and chemotherapy drugs. For example, patients with kidney problems may be advised to avoid ibuprofen before, during and after receiving pemetrexed.
Patients should consult their doctors before taking any medications and supplements while receiving treatment.
06. Alimta Eligibility
Who Is Eligible for Alimta (Pemetrexed)?
Pleural mesothelioma patients who do not qualify for surgery may be eligible for Alimta with cisplatin. This includes anyone who has inoperable pleural mesothelioma. Alimta is also approved for the treatment of non-small cell lung cancer.
Mesothelioma patients should talk with their doctor about Alimta to determine if they may be eligible. Doctors will discuss the benefits and potential risks associated with the treatment. They can help patients understand all of their mesothelioma treatment options and guide them through the decision process.
07. Alimta Studies
Clinical Trials and Studies on Alimta (Pemetrexed) for Pleural Mesothelioma
Many studies and clinical trials have been conducted concerning Alimta for mesothelioma.
One of the most important studies on Alimta was published in 2005. Researchers studied the use of Alimta and cisplatin as a second-line treatment in a phase 3 trial. In the study, patients who received a second-line treatment of the combination had a median survival of 15.3 months.
Researchers continue to study how the drug may be combined with other therapies for positive patient outcomes.
One such study combined Avastin (bevacizumab) with Alimta and cisplatin. Bevacizumab is an anti-angiogenesis drug, which blocks blood supply to cancerous cells. As a result, it can help prevent mesothelioma from spreading. Pleural mesothelioma patients who received all three drugs had a median survival of 18.8 months. Those who received only Alimta and cisplatin had a median survival of 16.1 months.
This study prompted the National Comprehensive Cancer Network (NCCN) to update their guidelines for treating mesothelioma in 2016. In addition to pemetrexed plus cisplatin, the panel recommended bevacizumab with cisplatin and pemetrexed as a first-line treatment for patients with unresectable pleural mesothelioma.
Tumor Treating Fields (TTFields) have also been used in combination with Alimta. TTFields use low-intensity electrical fields to inhibit cell division, which can slow or halt cancer growth. In 2019, the FDA approved a TTFields treatment called the NovoTTF-100L™ System. The approval applies to the NovoTTF-100L System combined with pemetrexed and platinum-based chemotherapy.
The treatment combination is a first-line treatment for pleural mesothelioma patients. The NovoTTF-100L System is also known by the brand name Optune Lua™. With this approval and increased interest around this treatment regimen, Optune Lua has become more widely available in recent years.
Researchers continue to conduct mesothelioma clinical trials to test these and other treatments in an effort to extend patient life expectancy.