What is Alimta

Today’s standard of care for treatment of pleural mesothelioma is the intravenous therapy of the drugs pemetrexed and cisplatin. Mesotheliomacancer is directly caused by exposure to asbestos fibers. The time of exposure may be 30 or more years prior to the discovery of this disease. There is no cure for mesothelioma. Mesothelioma is most commonly discovered in the pleura, the lining of the lungs; however, there is another type called peritoneal mesothelioma found in the peritoneum, the lining of the heart.

Mesothelioma is an extremely aggressive type of cancer resistant to many of the standard treatment procedures. Diagnosis of the cancer does not occur until the late stage of the disease’s progression. Even though mesothelioma has no known cure, for patients who are in the later stage of the disease and who would not benefit from surgery, chemotherapy using pemetrexed and cisplatin becomes the best chance to reduce the severity of symptoms and to extend life.

Pemetrexed is the generic name for a drug manufactured under the trade name Alimta. The introduction of pemetrexed/Alimta which has come to be known as Alimta therapy was in 2002, and the FDA approved the use of Alimta with cisplatin in 2004. This combination was not only the first chemotherapy treatment approved to treat mesothelioma; it remains the only approved treatment to this day.

Pemetrexed is a class of chemotherapy drug called an antifolate. A number of antifolates have been studied for treating mesothelioma, but pemetrexed has shown the most effectiveness. Antifolates inhibit the role that folate (folic acid) plays in the cycle of cell growth and multiplication. Antifolates inhibit the activity of folic acid during DNA synthesis, an essential in cell growth and replication. Specific enzymes are necessary for the production of DNA and RNA needed for all cell growth. Pemetrexed interferes with the production of these enzymes disrupting cell replication and cell division. Pemetrexed’s/Alimta’s ability to slow down the growth rate of malignant mesothelioma cancer cells is currently unsurpassed by any other chemotherapy drugs.

Studies confirm the clinical benefits of Alimta therapy in the treatment of advanced state mesothelioma include:

• Alimta therapy has been demonstrated to increase median survival time.
• Chemotherapy using Alimta has been shown to slow the progression of mesothelioma cancer.
• Alimta therapy helps to lessen the severity of and control symptoms of the disease.
• Studies have shown that Alimta therapy helps to improve the quality of life for those suffering with mesothelioma cancer.

Compared to other chemotherapy medications, Alimta has a much more convenient method of delivery. Alimta is given by intravenous injection by a healthcare provider usually over a time period of ten to fifteen minutes, once every three weeks. The dosage of the medication is based on body size, current and previous response to the chemotherapy, and on the patient’s medical condition—ability to tolerate the drug. Your doctor will instruct you to take folic acid vitamins and receive shots of vitamin B-12 prior to and during the chemotherapy treatment with Alimta. Vitamins containing folic acid are available over the counter without prescription. Folic acid can be found as well in many multivitamin products. Folic acid should be taken daily at least five out of the seven days prior to your first dose of Alimta, during the chemotherapy treatment itself, and for three weeks following your last chemotherapy treatment. A vitamin B-12 shot will be given to you in a muscle one week prior to your first dose of Alimta and once every nine weeks during your chemotherapy treatment.

Skin rashes/reactions are common during chemotherapy so your doctor will prescribe dexamethasone, a corticosteroid which should be taken near the time of each treatment. The oral steroid dexamethasone is taken twice a day on the day prior to the chemotherapy treatment and also on the day following the Alimta therapy. This medication is not recommended for patients who have blood cell disorders such as leukopenia, anemia, or thrombocytopenia. It is also not recommended for those with liver or kidney problems.

Unfortunately along with the benefits of chemotherapy come side effects. The following side effects may be suffered by mesothelioma cancer patients who have received the drug pemetrexed/Alimta:

• Nausea/vomiting—avoiding eating before treatment may help relieve the nausea to some extent, but in some cases other drugs may be needed to be taken to prevent or relieve nausea and vomiting.
• Stomach upset
• Constipation or diarrhea
• Allergic reaction—serious allergic reactions to Alimta are not likely to occur, but symptoms of such a reaction include developing a rash, itching and swelling especially of the tongue or throat, difficulty breathing, and extreme dizziness. Seek medical help immediately if these symptoms of allergic reaction occur.
• Weakness/tiredness
• Loss of appetite
• Mouth sores
• Rapid heartbeat or tachycardia
• Yellowing of the skin or eyes
• Chest pain
• Tingling/numbness of the feet or hands
• Fever and chills with a persistent sore throat (Chemotherapy can decrease the body’s ability to fight off infections.)
• Becoming easy to bruise/bleed
• Low blood-cell counts—Alimta can suppress bone marrow function, and this may result in low blood cell counts. Low red blood-cell counts may make the patient feel tired, become tired easily, and appear pale. Low white blood-cell counts may increase the chance for infections. Low platelets increase the chance for bleeding.

• Used in combination with the platinum-based medication cisplatin (the more traditional chemotherapy medication), Alimta is the only chemotherapy medication approved by the FDA for the specific treatment of malignant pleural mesothelioma, cancer of the lining of the chest cavity, when surgery is not an option.
• Alimta has also been approved by the FDA for treatment of patients with advanced nonsquamous non-small cell lung cancer (NSCLC). This is one specific type of NSCLC; Alimta is not recommended/indicated for use in patients who have squamous cell lung cancer, a different type of NSCLC.
• Alimta has been FDA approved as a single agent (used alone)for treatment of patients who have advanced nonsquamous non-small cell lung cancer after previous chemotherapy has been administered.