Pemetrexed
Pemetrexed (brand name Alimta) is an antifolate chemotherapy drug that is the backbone of the standard first-line mesothelioma chemotherapy regimen. Approved by the FDA in 2004 for use with cisplatin, pemetrexed works by disrupting folate-dependent metabolic processes essential for cancer cell DNA synthesis and replication.
The approval of pemetrexed in combination with cisplatin was a landmark moment in mesothelioma treatment. The pivotal EMPHACIS trial demonstrated that this combination improved median survival from 9.3 months (cisplatin alone) to 12.1 months, establishing the first chemotherapy regimen to show a clear survival benefit in mesothelioma.
Pemetrexed is administered intravenously, typically every 21 days for 4–6 cycles. Patients must take folic acid supplements and vitamin B12 injections before and during treatment to reduce side effects, which can include fatigue, nausea, and low blood counts. Carboplatin may be substituted for cisplatin in patients who cannot tolerate cisplatin's kidney toxicity.
While immunotherapy with nivolumab plus ipilimumab is now an approved alternative first-line option, pemetrexed-based chemotherapy remains a standard treatment choice, particularly for patients with epithelioid cell type. Some treatment protocols combine chemotherapy and immunotherapy sequentially.
- Also known as
- Alimta
- Category
- Treatment
- Related terms
- Cisplatin, Chemotherapy, Immunotherapy, Mesothelioma, Clinical Trial
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