Alimta

Quick Summary

Alimta is the brand name of the chemotherapy drug pemetrexed, which is used to treat malignant pleural mesothelioma cancer. Alimta is known for being effective in combating mesothelioma, and for prolonging the lives of patients as well as improving their quality of life.

What is Alimta?

Alimta (Pemetrexed) was developed by American chemist Edward C. Taylor at Princeton University. It is manufactured by Eli Lilly and Company, a global pharmaceutical company based in Indianapolis known for many notable achievements in the industry. In February 2004, Alimta became the first mesothelioma chemotherapy drug to receive approval from the U.S. Food and Drug Administration (FDA).

This approval was to treat pleural mesothelioma and non-small cell lung cancer, in combination with cisplatin, in patients who were not eligible for surgery, or for those whose cancer was unresectable, meaning the cancerous tissue could not be completely removed by surgery. Later, in 2008, the U.S. FDA approved Alimta for use as a first-line chemotherapy treatment on its own.

Known for being the most promising chemotherapy drug to treat mesothelioma patients, Alimta is used as the standard baseline comparison to other chemotherapy drugs in clinical trials.

How is Altima Administered?

Alimta is administered to mesothelioma patients who do not qualify as candidates for surgery to remove the cancerous tissue. This chemotherapy drug is administered through intravenous (IV) injection. The recommended dosage is 500 mg, and typically each dose is administered over ten to fifteen minutes. To increase its effectiveness, Alimta is regularly administered with other chemotherapy drugs, such as cisplatin.

Altima Treatment Update

Altima treatment is done over a three-week, or 21-day cycle. The first day of treatment includes one dose of Alimta and often followed thirty minutes later by a dose of cisplatin, which is administered over two hours. This cycle is repeated every three weeks and lasts as long as the mesothelioma healthcare specialist recommends.

Blood tests are also done before treatment begins and during treatment. These blood tests are done to monitor a patient’s blood cells and other substances found in the blood. These tests also monitor liver and kidney function during treatment.

In addition, Alimta can be administered as a secondary therapy, prescribed when the first-line of chemotherapy was not successful. Patients who have entered remission may also undergo Alimta chemotherapy as a maintenance treatment to extend their remission.

How Does Altima Treat Mesothelioma?

The pemetrexed drug, Alimta, is a multitargeted antifolate, the first class of antimetabolites.

Alimta treats malignant pleural mesothelioma by inhibiting the three enzymes:

  • Thymidylate synthase (TS)
  • Dihydrofolate reductase (DHFR)
  • Glycinamide ribonucleotide formyltransferase (GARFT)—used in the body’s synthesis of purine and pyrimidine

Purine and pyrimidine nucleotides are required in the production of DNA and RNA, which means Alimta prevents their formation.

More simply put, Alimta blocks the enzymes the cancer cells require to grow and repair, effectively slowing or stopping the spread of a patient’s cancer.

Alimta Drug Combinations

Alimta can be administered on its own, or in combination with other chemotherapy drugs.

Alimta and cisplatin have been combined since Alimta was approved by the U.S. FDA in 2004, and remains the most common combination. This combination is considered to be the most effective pleural mesothelioma chemotherapy treatment for those patients who are not eligible for surgery.

A 2016 study which cross-referenced data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database with claims data from Medicare revealed the treatment plan of Alimta and cisplatin together is the most common combination for chemotherapy patients. Past clinical trials have revealed that the life expectancy of patients who receive the Alimta-cisplatin drug combination is longer than those who do not undergo chemotherapy or those who only receive treatment with cisplatin.

In cases of advanced non-small cell lung cancer, Alimta is also commonly administered with the chemotherapy drug Carboplatin for the first-line treatment. Like Alimta and cisplatin, Carboplatin is also administered intravenously.

Current Alimta Clinical Trials

Mesothelioma is known for being an aggressive form of cancer, and as such research is being done in labs around the world to find more effective drug combinations to treat this disease.

Recently, in 2016, the National Comprehensive Cancer Network (NCCN) amended its first-line treatment recommendation and included the drug bevacizumab (brand name Avastin) as a recommended combination with Alimta and cisplatin. It is expected that the U.S. FDA will consider adopting the addition of bevacizumab, following the National Comprehensive Cancer Network’s recommendation.

Even more recently, in 2017, a Japanese study found that the combination of Alimta and cisplatin can also be successful in treating peritoneal mesothelioma.

Patients who are not candidates for cytoreductive surgery can instead be treated with Alimta and cisplatin, to extend their lives and improve their quality of life by reducing their symptoms.

Another notable Alimta clinical trial includes a study sponsored by the National Cancer Institute (NCI). This trial is testing the combination of methoxyamine, a drug that improves the effectiveness of chemotherapy treatment, with Alimta and cisplatin, in treating patients whose mesothelioma progressed after undergoing a previous chemotherapy treatment.

Sponsor Baylor College of Medicine’s Mesothelioma Treatment Center is leading an ongoing trial with 36 participants, testing the combination of Alimta with cisplatin with the objective of finding the maximum tolerated dose of these drugs by intrathoracic administration, when combined with cytoreductive surgery. The expected completion date of this study is August 2018.

A clinical trial by Targovax Oy currently in its second phase, with researchers working to determine “the safety, tolerability, and efficacy of ONCOS-102 in combination with chemotherapy”, which includes chemotherapy drugs Alimta and cisplatin. ONCOS-102 is Targovax’s lead immunotherapy drug, created to induce systemic, anti-tumor responses.

Alimta Side Effects

As with all chemotherapy drugs, mesothelioma cancer patients do experience side effects. These side effects vary and typically range from mild to moderate in nature. Some patients may experience severe side effects and should inform their doctor immediately in these cases.

When administered alone, Alimta can cause common side effects such as:

  • Fatigue
  • Nausea
  • Loss of appetite

When taken with cisplatin, common side effects of Alimta include:

  • Constipation
  • Low platelet count (thrombocytopenia)
  • Low red blood cell count (anemia)
  • Low white blood cell count (neutropenia)
  • Swelling or sores in the mouth
  • Sore throat
  • Vomiting

Alimta can cause more serious side effects including low blood cell counts, including low white and red blood cell counts, and low platelet counts. Patients may also experience fatigue or fever. Other severe side effects include kidney problems or kidney failure, and lung problems (pneumonitis). Other side effects include skin reactions, such as blisters, skin peeling, and sores or ulcers in the mouth, throat, nose, or genitals.

Finally, Alimta patients can experience radiation recall, which is a skin reaction in patients who have undergone radiation treatment before. Radiation recall takes the form of swelling, blistering, or redness of the skin that is similar to a sunburn in the area that has been previously exposed to radiation. It’s important to speak with a doctor immediately if any of these severe side effects are experienced.

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Sources
  1. NCBI. “First-line chemotherapy with pemetrexed plus cisplatin for malignant peritoneal mesothelioma.”
    Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28594258. Accessed January 7th, 2018.
  2. ClinicalTrials.Gov. “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 Pemetrexed Disodium and Cisplatin or Carboplatin” Retrieved from: https://clinicaltrials.gov/ct2/show/NCT02535312. Accessed January 7th, 2018.
  3. ClinicalTrials.Gov. “Study of Cytoreductive Surgery and Hyperthermic Intraoperative Chemotherapy With Pemetrexed and Cisplatin for Malignant Pleural Mesotheliomas.” Retrieved from: https://clinicaltrials.gov/ct2/show/NCT02838745. Accessed January 7th, 2018.
  4. ClinicalTrials.Gov. “A Randomised Phase II Open-label Study With a Phase Ib Safety lead-in Cohort of ONCOS-102, an Immune-priming GM-CSF Coding Oncolytic Adenovirus, and Pemetrexed/Cisplatin in Patients With Unresectable Malignant Pleural Mesothelioma.” Retrieved from: https://clinicaltrials.gov/ct2/show/NCT02879669. Accessed January 7th, 2018.
  5. Alimta. Retrieved from https://www.alimta.com/. Accessed January 7th, 2018

Last modified: May 7, 2018