Alimta: The Promising Chemo Drug for Mesothelioma and NSCLC

Alimta is the brand name for the chemotherapy medicine pemetrexed. It is a cancer medicine that can treat mesothelioma and certain kinds of nonsquamous non-small cell lung cancer (NSCLC). It can also prolong and increase the quality of life in some mesothelioma patients when used in combination with another chemotherapy medication, cisplatin. 

 

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What Is Alimta?

Alimta is an FDA-approved drug for treating nonsquamous non-small cell lung cancer and malignant mesothelioma. Alimta appears to hold the most promise for extending mesothelioma life expectancy.  It is a chemotherapy drug that prevents DNA replication and cell division, thereby resulting in cell death. 

 

What Is Alimta Used To Treat?

Alimta is prescribed for the treatment of two kinds of cancer [3]:

Malignant pleural mesothelioma: This is a cancer of the lining of the lungs. Alimta is used in individuals who have never used chemotherapy and whose cancer cannot be surgically removed.

Locally advanced or metastatic nonsquamous non-small cell lung cancer: Alimta is used alone, in combination with cisplatin, or in combination with both cisplatin and pembrolizumab to treat patients who have already received anticancer treatment. Those who have had prior platinum-based chemotherapy can also use Alimta by itself if their disease has not progressed after four cycles of previous therapy. 

 

How Does It Work?

Alimta is a chemotherapy medicine known as an antifolate. It works by preventing cells from dividing and spreading. More specifically, it works by stopping cells from using folate to aid in their own replication. Both healthy and cancer cells are affected by it. However, because cancer cells have fewer error-correcting capabilities, they are affected much more than healthy cells. 

 

Side Effects of Alimta

Alimta’s side effects might vary from mild to severe. The following are some of the mild and most severe side effects of taking Alimta [4][2][1]:

Mild Side Effects 

Mild side effects include the following:

• Constipation
• Weight loss
• Diarrhea
• Nausea
• Loss of appetite
• Vomiting
• Tiredness

The above-mentioned side effects may last only a few days to a few weeks. However, some side effects may stay longer, become severe, or be unpleasant. If you are worried about the side effects, consult your doctor or pharmacist.

Serious Side Effects  

Serious side effects include the following:

• Low blood cell counts: Symptoms are fever, bleeding, severe tiredness, or any signs of infection. 

• Serious skin problems: Symptoms include blisters, skin sores, skin peeling, or ulcers in the mouth, nose, throat, or genital area. 

• Kidney failure: Symptoms include decreased urine output, fatigue, vomiting, nausea, and dry or itchy skin.

• Interstitial pneumonitis: Symptoms include cough, fever, and dyspnea.

If you have serious side effects from Alimta, contact your doctor right away.

 

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How To Manage Side Effects of Alimta

Some drugs or vitamins can help reduce side effects. Both folic acid and vitamin B12 are essential during Alimta therapy. Your doctor will start you on once daily folic acid 1 week before your start of treatment and will continue until 3 weeks after your last treatment. Vitamin B12 will be given as an injection starting 1 week before treatment and subsequently once every three cycles. 

To reduce nausea and exhaustion, corticosteroids such as dexamethasone may be prescribed starting 3 days prior to each treatment.

 

Precautions

• Before beginning Alimta therapy, inform your doctor about any other drugs you are taking. Unless your doctor authorizes it, do not use aspirin or aspirin-containing products. 

• Do not use nonsteroidal anti-inflammatory medicines like ibuprofen without your doctor’s permission.

• Do not receive immunizations or vaccinations while taking Alimta without your doctor’s permission.

• Before beginning this treatment, tell your doctor if you are pregnant or think you could be pregnant. Alimta is very harmful to a developing fetus. 

• Avoid becoming pregnant while using this medication. Please use condoms and other barrier contraceptive methods. Consult your doctor about when you may safely become pregnant or conceive a child after therapy.

• Do not breastfeed if you are on this medicine.

 

Dosage and Treatments

Alimta is given through an IV line by injection. Each dosage takes around 10 minutes to administer. Alimta is administered in patients with a kidney creatinine clearance of 45 ml/min or greater. 

Below are the recommended dosages [1]:

• In combination with cisplatin and pembrolizumab: On Day 1 of each 21-day cycle, Alimta is given at a dose of 500 mg/m2 after pembrolizumab. Thirty minutes after Alimta, 75 mg/m2 of cisplatin is administered.
• As a single agent or in combination with cisplatin: On Day 1 of each 21-day cycle, a dose of 500 mg/m2 of Alimta is recommended.

 

Cost

100 mg Alimta intravenous powder for injection costs approximately $860. However, your insurance plan and location will determine the actual cost. The price of Alimta, like all drugs, varies.

 

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FAQs

Below are answers to some of the most commonly asked questions regarding Alimta.

What should I avoid when using Alimta?

If you have kidney problems, you should avoid taking Advil and Motrin for 2 days before or after taking Alimta. Your doctor may adjust the dose of this medication so as not to harm your kidneys. Stay away from persons who are sick or have infections. Avoid activities that put you at risk of bleeding or injury. Do not receive a live vaccination, and avoid contact with anyone who has just gotten a live vaccine.

Is Alimta a type of chemotherapy or immunotherapy?

Alimta, the brand name for pemetrexed, is a chemotherapy medication used to treat mesothelioma and non-squamous non-small cell lung cancer.

Why is B12 given with Alimta?

Alimta is given with vitamin B12 to reduce the chance of serious side effects. B12 reduces the chance of decreases in the bone marrow and blood cells. Bone marrow and blood cell decrease can lead to anemia, bleeding, and infection.

Patients are usually given a vitamin B12 injection one week before their first Alimta dosage and then every three cycles after that. Doctors also prescribe folic acid and a corticosteroid medication to help with side effects.

What is the Alimta chemotherapy success rate?

According to the Phase II trial of Alimta, people treated with the Alimta+cisplatin+radiation arm achieved a two-year overall survival rate of 57.6% [5]. It also showed an overall response rate of 46.2%, although only 3.8% of patients had a complete response whereas 42.3% of patients showed a partial response. 

 

 

REFERENCES:

1. Dosage forms and strengths – Food and Drug Administration (no date). Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021462s021lbl.pdf (Accessed: February 19, 2023). 
2. FDA Expands Lilly’s ALIMTA® (pemetrexed) Label with Combination of KEYTRUDA® (pembrolizumab) and Platinum Chemotherapy for the First-Line Treatment of Metastatic Non-squamous Non-Small Cell Lung Cancer | Eli Lilly and Company. (n.d.). Eli Lilly and Company. https://investor.lilly.com/news-releases/news-release-details/fda-expands-lillys-alimtar-pemetrexed-label-combination
3. ResearchFirst Generic Drug Approvals. U.S. Food And Drug Administration. https://www.fda.gov/drugs/drug-and-biologic-approval-and-ind-activity-reports/first-generic-drug-approvals
4. These highlights do not include all the information needed to use ALIMTA safely and effectively. See full prescribing information for ALIMTA.ALIMTA (pemetrexed for injection), for Intravenous UseInitial U.S. Approval: 2004. (n.d.). https://uspl.lilly.com/alimta/alimta.html#pi
5. Lung Cancer Study Showed Encouraging Results For ALIMTA-based Regimens And Full-dose Radiation | Eli Lilly and Company. (n.d.). Eli Lilly and Company. https://investor.lilly.com/news-releases/news-release-details/lung-cancer-study-showed-encouraging-results-alimta-based#:~:text=Patients%20treated%20on%20the%20ALIMTA,%2C%2029.3%2D59.8%20months).
6. Li, J., Chi, Y., Cao, G., Zhao, J., An, T., Wu, M., Wang, Y., Zhuo, M., Yang, X., Jia, B., Chen, R., Wang, J., Zhai, X., & Wang, Z. (2021). Efficacy and safety of pemetrexed maintenance chemotherapy for advanced non-small cell lung cancer in a real-world setting. Journal of Thoracic Disease, 13(3), 1813–1821. https://doi.org/10.21037/jtd-21-337

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