Alimta

What Is Alimta (Pemetrexed)?

Alimta, or pemetrexed, is a chemo drug approved to treat mesothelioma and lung cancer. Doctors have prescribed it as part of the standard chemo protocol for mesothelioma for decades. 

In September 2024, the U.S. Food and Drug Administration approved Keytruda (pembrolizumab) in combination with Alimta and cisplatin. 

The FDA first approved Alimta with cisplatin, a platinum-based chemo drug, in 2004. 

Key Facts About Alimta

1. Patients receive Alimta via IV every 21 days. They also receive vitamin B12, folic acid and corticosteroids to minimize side effects.
2. Alimta is a cornerstone therapy in mesothelioma treatment. It extends survival and improves symptoms.
3. Common side effects include fatigue, nausea, anemia and low white blood cell counts. 
4. Alimta works well and has mild side effects. It gives mesothelioma patients hope for better outcomes.

Alimta arrives at cancer centers in a powder that is mixed into a liquid for injection. Eli Lilly held a patent for Alimta blocking generic availability of pemetrexed until 2022. Now generics have become available, including Pemfexy. It arrives at cancer centers already in liquid form.

Alimta can prolong life expectancy with mesothelioma. It also improves quality of life, reducing symptoms like breathing difficulties and pain. 

How Does Alimta Treat Mesothelioma?

Alimta blocks DNA replication and prevents mesothelioma cells from rapidly dividing. This prevents mesothelioma from growing and kills them. 

Because it blocks the production of folate, Alimta is considered an antifolate antimetabolite. This means it disrupts enzymes involved in cell metabolism.

Dr. Jennifer M. Suga at Kaiser Permanente Medical Center tells us Alimta is more effective when combined with other drugs. “Combining pemetrexed with platinum drugs showed more than 20% improvement in treatment response with more growth control and survival time,” says Dr. Suga.

The recommended dosage for Alimta is 500 mg/m2. A nurse administers it through a port or an IV line for 10 minutes. The guidelines recommend 21 days, known as a cycle, between each IV infusion.

Alimta Treatment for Pleural Mesothelioma

Alimta can help slow tumor growth and kill pleural mesothelioma cells. It improves chest pain, shortness of breath and cough. Alimta has been shown to help pleural patients live around 18 months, particularly when combined with other mesothelioma treatments. 

Alimta with cisplatin is the most common chemo regimen for first-line pleural treatment. Though some patients tolerate carboplatin better than cisplatin. These drugs help most patients live around 16 months. A phase 3 trial found adding Keytruda increases median survival to 17.3 months. 

Doctors may recommend chemo with immunotherapy or targeted therapy for advanced cases. Early-stage cases may receive chemo in combination with surgery and radiation. A study of Tumor Treating Fields with Alimta and cisplatin showed a median survival of 18.2 months. A targeted drug trial of Avastin (bevacizumab) with Alimta and cisplatin reported 18.8 months of survival. But there’s a greater risk of adverse events with Avastin.

Alimta Treatment for Peritoneal Mesothelioma

Doctors use Alimta with cisplatin as a systemic therapy, or whole body therapy, for peritoneal mesothelioma. Similar to treatment plans for pleural patients, doctors often pair Alimta with other mesothelioma medications for peritoneal patients. 

Doctors have also used Alimta alone for maintenance chemo. It helps inoperable patients live longer and improves cancer symptoms. Alimta helps peritoneal patients live up to 23 months.

A 2023 case report discussed a peritoneal patient who lived more than 5 years on Alimta maintenance therapy. Doctors generally don’t use Alimta for heated intraperitoneal chemotherapy. That’s because it can lead to significant gastrointestinal toxicity. 

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What Are the Benefits of Alimta (Pemetrexed) for Mesothelioma Patients?

Alimta controls tumor growth, helping mesothelioma patients live longer. It’s a key therapy for this disease, alone or with other treatments. Up to 45% of mesothelioma patients respond to Alimta and cisplatin. 

Adding Keytruda helps more patients respond and boosts survival. About 18% more patients respond with the addition of Keytruda. They live at least a month longer and have a 21% reduction in the risk of death.

How Alimta Benefits Mesothelioma Patients 

• Combination Potential: Effective with other therapies, like immunotherapy, chemo and targeted drugs.
• Improves Survival: Alimta can extend survival for all types and stages of mesothelioma.
• Slows Disease Progression: Pemetrexed limits cancer cell growth and has the potential to shrink tumors.
• Symptom Relief: Reduces symptoms like pain and difficulty breathing. It also improves fluid buildup in the abdomen and around the lungs.
• Well-Tolerated: Side effects are manageable with supplements and corticosteroids.
• Widely Available: Accessible in many mesothelioma cancer centers worldwide.

Plural mesothelioma survivor Lyn Johnson credits Alimta and cisplatin for her survival. Five years after receiving the combo, she said it was the only treatment her body could tolerate.

“I was offered Alimta and cisplatin. I can’t lie, this is a hard regime. After 4 sessions I had a scan,” Lyn said. “My oncologist thought he could see, perhaps, a slight reduction. After the next scan my oncologist couldn’t believe how much it had shrunk!”

What Are the Side Effects of Alimta (Pemetrexed)?

Alimta side effects are usually mild to moderate for most mesothelioma patients. Some patients may experience extreme side effects. Inform your doctor of any side effects so they can help you manage them. 

Tell your doctor before taking Alimta if you use a non-steroidal anti-inflammatory drug. It may cause a drug interaction. NSAIDs include ibuprofen, naproxen, indomethacin and ketoprofen.

Common Alimta Side Effects

• Anemia 
• Anorexia 
• Constipation
• Fatigue 
• Low blood cell counts
• Nausea and vomiting
• Sores and swelling in the mouth and throat

Mesothelioma patients say taking folic acid and B12 help them tolerate Alimta. For this reason, doctors require these vitamins with pemetrexed therapy.

Patients who are pregnant shouldn’t take Alimta because it could harm the unborn baby. If you’re considering Alimta, tell your doctor if you have kidney or liver disease, a weak immune system or excess fluid in your chest cavity.

Kevin Hession

Verified Asbestos.com Survivor

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Kevin Hession says he actually gained weight following his chemotherapy treatments. “I’ve never had a bad experience with chemotherapy,” Kevin said. “My worst case on a scale of 1 to 10 has probably been a 3.” His treatments have gone so well he was offered an option to take what he calls a “chemo holiday.”

Kevin Hession

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Who Is Eligible for Alimta Treatment?

Eligibility to receive pemetrexed for mesothelioma depends on your diagnosis and overall health. Doctors assess patients based on the following criteria.

Eligibility Criteria for Pemetrexed

• Blood Cell Count: Enough counts of red, white and platelet cells are vital. They reduce severe side effects.
• Diagnosis: Doctors prescribe Alimta for pleural and peritoneal mesothelioma.
• General Health: Patients must have good health to tolerate chemotherapy.
• Kidney Function: Alimta is cleared through the kidneys. So, it requires adequate kidney function. 
• No Contraindications: Consult your doctor about the risks and benefits of taking Alimta. Anyone with certain conditions should take precautions. Examples include liver disease or a weak immune system.
• Stage of Disease: It’s commonly prescribed for all stages of mesothelioma.

Eligibility is determined through an oncologist’s evaluation. Ongoing monitoring ensures the treatment remains safe and effective throughout therapy.

Research On Alimta in Mesothelioma Treatment

Mesothelioma clinical trials continue to do research on more effective drug combinations with Alimta. Pemetrexed is used as the baseline chemotherapy drug for these combinations.

Current Clinical Trials On Alimta 

• Carboplatin, Volrustomig and Alimta: A phase 3 trial is combining Volrustomig (MEDI5752) with Alimta and carboplatin. Volrustomig is a monoclonal antibody immunotherapy drug.
• Cisplatin, Imfinzi and Alimta: A phase 3 trial of cisplatin and Alimta with Imfinzi (durvalumab) is underway. Imfinzi is an immunotherapy drug. The phase 2 trial reported a median survival of 20.4 months for pleural patients.

The National Comprehensive Cancer Network recommends certain drug combos with pemetrexed. As of 2025, they include cisplatin or carboplatin with or without Keytruda or Avastin.

Common Questions About Alimta (Pemetrexed)

Is Alimta right for me?

If you have mesothelioma, talk to your oncologist about Alimta. It’s among the most prescribed treatments for all stages of mesothelioma. You may not qualify if you have severe kidney disease or low blood cell counts.

Can Alimta be used to treat other cancers besides mesothelioma?

The FDA approved pemetrexed as a first-line and maintenance therapy for lung cancer. Doctors prescribe Alimta for non-squamous non-small cell lung cancer. A 2017 study used it with carboplatin followed by maintenance with Alimta alone. The median survival was around 22.6 months.

What should I ask my doctor before starting Alimta treatment?

Before starting Alimta, ask your doctor about its benefits, side effects and how it fits into your treatment plan. Ask about pre-treatment supplements like folic acid and vitamin B12. Also inquire about necessary precautions, how to manage side effects and expected outcomes. Ask if Alimta interacts with your medications or health conditions.

How much does Alimta cost and does insurance cover it?

Alimta is expensive, often costing several thousand dollars per treatment without insurance. The total price depends on how many cycles you need. Many insurance plans cover Alimta for mesothelioma and lung cancer. 

Pemfexy might be more affordable, but the price may vary throughout the country. Patients should consult their insurer about co-pays and prior approval. A Patient Advocate can also help answer questions about insurance and financial assistance options.

What is the success rate of Alimta (pemetrexed)?

When combined with other treatments, Alimta helps mesothelioma patients live from 18 to 23 months. Response rates range between 45% and 63% depending on the combination. 

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