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Pricey Mesothelioma Drug May be Best Second-Line Treatment


The chemotherapy combination of pemetrexed (brand name Alimta) and cisplatin is typically the first-line drug treatment for patients with advanced malignant mesothelioma. But a new study on the combination published recently in the journal Lung Cancer suggests that a less expensive alternative may be just as effective.

Researchers from Oxford, England compared pemetrexed plus cisplatin to the newer combination of raltitrexed (brand name Tomudex) plus cisplatin and found that the two combinations produced nearly identical results in terms of survival in mesothelioma patients. The researchers obtained baseline progression and survival rates using data from an earlier multi-national trial looking at the effectiveness of cisplatin with or without raltitrexed for mesothelioma. They then compared these with the results of various randomized control trials conducted since then.

“Raltitrexed plus cisplatin and pemetrexed plus cisplatin were not found to be statistically significantly different with respect to overall response, progression free survival and overall survival,” writes lead author Beth Woods in a summary of the study. In terms of cost-effectiveness, the overall cost of a raltitrexed-based regimen for mesothelioma was found to be around $21,000 per quality adjusted life year, compared to more than $42,000 for other chemotherapeutic approaches.

But it was not all bad news for the makers of Alimta. The same issue of Lung Cancer contains another study on the effectiveness of the pemetrexed/cisplatin combination as a second line treatment for mesothelioma patients who have already been through one round of treatment. That study found that the pemetrexed/cisplatin mix was an effective second-line option for mesothelioma patients, particularly those who are younger or whose disease was held in check by the first line chemotherapy for a year or more.

However, the Italian researchers who conducted the mesothelioma study caution that it has many limitations, including the fact that it is retrospective and may reflect some selection bias. They call for additional clinical trials of pemetrexed/cisplatin as a second-line treatment for mesothelioma. To date, there is no standard second-line treatment for mesothelioma, a highly aggressive cancer caused by asbestos.


Zucali, PA et al, “Second-line chemotherapy in malignant pleural mesothelioma: results of a retrospective multicenter survey”, September 19, 2011, Lung Cancer (Epub ahead of print) Woods, B et al, “Raltitrexed plus cisplatin is cost-effective compared with pemetrexed plus cisplatin in patients with malignant pleural mesothelioma”, September 19, 2011, Lung Cancer (Epub ahead of print) “Phase III Randomized Study of Cisplatin with or without Raltitrexed in Patients with Malignant Pleural Mesothelioma”, December 2007. National Cancer Institute, Clinical Trials.

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