Alimta® is the brand name for pemetrexed, and was approved by the FDA in 2004 for use in the treatment of malignant mesothelioma, often in combination with a second form of chemotherapy, such as cisplatin or carboplatin. Alimta® is the first chemotherapy drug approved specifically to treat mesothelioma patients who are not eligible for surgery. Your doctor will speak to you about whether Alimta® is appropriate for your specific type of mesothelioma as well as appropriate combination therapies.
Cancer occurs in the body when cells divide and grow uncontrollably. Alimta® slows cell division by blocking the specific DNA making processes that cells require to divide and reproduce. Alimta® disrupts the action of 3 specific enzymes required for cancer growth. The quickly multiplying cancer cells are more likely to be affected by Alimta® than their healthy counterparts, but healthy cells can be affected causing unwanted side effects. You should discuss the side effects with your oncologist. .
Alimta® is delivered intravenously, and each injection or infusion will last about 10 minutes. You will usually receive Alimta® once every 21 days (3 weeks). If given in combination with cisplatin or carboplatin, typically, you will receive the Alimta® infusion first followed by the cisplatin or carboplatin 30 minutes or so later.
Your oncologist should be made aware if you have liver or kidney problems before starting Alimta® therapy or should severe side effects occur during treatment.
Before and during Alimta® treatments, your physician may also prescribe folic acid, vitamin B12, and oral steroids to reduce side effects and toxicity of the treatment.
- Folic acid may be taken orally once a day beginning 7 days before receiving Alimta® therapy. Your mesothelioma healthcare team may prescribe a specific dosage for each individual, generally between 400 and 1000 mcg each day. The folic acid may be prescribed to be taken orally every day during the time you are getting treatment and for 21 days after your last treatment.
- Vitamin B12 injections may be given by your doctor while you are being treated with Alimta® in an attempt to lower your risk of certain harmful side effects. You may receive your first vitamin B12 injection 1 week before your first dose of Alimta and approximately every 9 weeks during treatment
- A corticosteroid, oral steroid medication, may be prescribed during each Alimta® treatment. This drug is intended to be taken twice daily on the day before, the day of, and the day after Alimta® treatment, unless your healthcare team gives you different instructions. The corticosteroids lower the risk of skin reactions to Alimta®.
Regular blood tests will be done before and during Alimta® treatment to assist your mesothelioma healthcare team with deciding whether to continue treatment and/or change dosages. This decision is based on the results of previous treatment and any side effects that you have experienced. It is important to discuss any side effects with your team to enable them to monitor how your treatment is going.
Side effects can vary from patient to patient. Many side effects such as blood cell count will be monitored through regular blood tests. Some side effects many only last for a short time as your body adjusts to medication. Any side effects should be discussed with your doctor so they are aware of their presence and they can answer questions you may have and may be able to help you prevent or reduce them.
Call your healthcare team right away if you have a fever, chills, diarrhea, or mouth sores. These symptoms could mean you have an infection which may be severe. Below you will find some of the most common and/or most serious side effects experienced by mesothelioma patients being treated with Alimta® plus cisplatin or carboplatin:
- Low white blood cell count (neutropenia/leukopenia)
- Low red blood cell count (anemia)
- Low platelet count (thrombocytopenia)
- Tiredness (fatigue)
- Gastrointestinal (GI) upset
- Nausea and/or vomiting - It is important to tell your doctor if you have nausea or vomiting. There are medications that can help prevent and treat such symptoms.
- Loss of appetite
- Constipation – Your doctor can help you treat your constipation. It is important that you talk with them before you take any over-the-counter laxatives or stool softeners.
- Diarrhea- Tell your doctor if you have diarrhea. It is very important that you talk with them before you take any over-the-counter diarrhea medicines.
- Redness or sores in your mouth, throat, on your lips, or in the tube that connects your throat and stomach.
- Hair loss (alopecia)
- Nerve damage- weakness, pain, tingling sensation and/or numbness
You must always be aware of infection. You should also call your healthcare team right away if you notice any other changes in your body or experience any of the following symptoms during your chemotherapy treatment. Your healthcare team will advise you accordingly:
- A one-time temperature above 101°F, or a temperature above 100.4°F for more than 1 hour
- Confusion or a change in mental status, including hallucinations
- Difficulty breathing
- A new rash
- Trouble swallowing, drooling, or facial, neck, or tongue swelling
- Increased pain
- Abdominal pain
- Constipation or uncontrollable diarrhea
- Uncontrollable nausea and/or vomiting
- Swelling in legs or arms