Raltitrexed (Tomudex)

What Is Raltitrexed?

Raltitrexed is a chemotherapy drug that received approval in the U.K. and Europe in the 1990s as a treatment for colorectal cancer. Clinical trials in Canada and Europe continue to investigate the drug in people with mesothelioma.

Doctors primarily use raltitrexed as an alternative to 5-fluorouracil for advanced colorectal cancer. It has also been used to treat mesothelioma, stomach (gastric) cancer, pancreatic cancer, head and neck cancer and non-small cell lung cancer.

While not available in the U.S., other countries use it interchangeably with pemetrexed. These countries include Canada, Mexico, the United Kingdom and European nations. Many U.K. doctors recommend it because it is less expensive.

However, the results are not as good as the combination of cisplatin and pemetrexed (Alitma) — the most common chemotherapy drugs used for treating mesothelioma.

Raltitrexed Information

Professor and chemist Ken Harrap developed Raltitrexed in England in the 1980s. He also developed carboplatin, an alternative to cisplatin that causes fewer side effects.

Raltitrexed works by disrupting the way cancer cells grow. It damages the DNA of cancer cells, limits cell division and causes cancer cells to die. This is how raltitrexed may shrink tumors and slow their growth.

Raltitrexed is part of the antimetabolite group of cancer drugs. Antimetabolite is a medical term for drugs that block normal metabolism inside cells. These drugs interfere with DNA replication, which is how cells grow and divide to make more cells.

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Raltitrexed for Mesothelioma Treatment

Raltitrexed can kill mesothelioma cells as a singular therapy, but it is more effective when combined with other chemotherapy drugs. Most of the research has combined raltitrexed with a platinum-based drug such as cisplatin. A 2021 research study noted that raltitrexed demonstrated improved survival in combination with cisplatin in patients with the epithelioid type of mesothelioma.

In 2005, a phase III trial of raltitrexed and cisplatin reported that about 24% of participants responded with a median survival time of 11.4 months and a 1-year survival of 46%. These results aren’t as good as those achieved with cisplatin and pemetrexed where 41% of pleural patients respond with a median survival time of 12 months and a 1-year survival of 58%.

Mesothelioma clinical trials that combined raltitrexed with other chemotherapy drugs have produced mixed results. For example, raltitrexed and oxaliplatin have a low response rate, and median survival ranges from 14 weeks to 44 weeks across studies. Oxaliplatin is a third-generation platinum drug similar to cisplatin.

Raltitrexed Side Effects

Raltitrexed can harm healthy cells in addition to cancer cells. This harm can cause side effects that range from mild to severe.

Some patients also report headaches, mouth sores, hair loss, weight loss, increased sweating, swelling of hands and feet, muscle cramps and joint pain. Patients are also at an increased risk of getting an eye infection.

Tell your doctor if you develop any side effects right away. They can prescribe medication to control your side effects. They may also reduce your dose of raltitrexed until your side effects weaken.

Raltitrexed Warnings

The U.S. Food and Drug Administration has not reviewed raltitrexed for approval or issued any warnings about its use, but other international health agencies have issued warnings and contraindications.

For example, patients with kidney, liver or heart problems should not take raltitrexed. Women who are pregnant or breastfeeding should not take the drug.

Medical data shows higher treatment-related mortality rates with raltitrexed compared to 5-fluorouracil. Close monitoring of patients on raltitrexed and reducing the dosage as necessary helps to limit severe complications.

Raltitrexed is also known to make cancer cells more sensitive to radiation therapy. For this reason, doctors are careful when they combine raltitrexed with radiation therapy.

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