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Standard Chemotherapy Mix Still Best for Mesothelioma


Researchers at Japan’s Shizuoka Cancer Center and Juntendo University say the popular chemotherapy combination of cisplatin and Alimta (pemetrexed) should remain the gold standard for malignant pleural mesothelioma.

In a study published in Respiratory Investigations, the team, led by Takehito Shukuya, concluded that Alimta and the platinum-based drug cisplatin produced better long term results in mesothelioma patients than the combination of cisplatin and Gemzar (gemcitabine). Gemzar is a nucleoside analog that some studies have found to be a promising alternative to the more conventional Alimta-based mesothelioma treatment.

In a retrospective comparison study of the two treatment combinations, researchers examined the cases of 30 consecutive malignant pleural mesothelioma patients from July 2002 to December 2011. “We reviewed the medical charts of these patients and evaluated their characteristics as well as data regarding drug toxicity and antitumor efficacy,” Dr. Shukuya explains. Seventeen of the mesothelioma patients were treated with a combination of Alimta and cisplatin while the remaining 13 received cisplatin with Gemzar.

While 35% of the mesothelioma patients receiving Alimta saw a response to treatment, only 15% of the Gemzar group responded. The time it took for mesothelioma tumors to begin growing again after treatment was also significantly longer in patients on Alimta (median 215 days) than it was for those on Gemzar (median 142 days). Just as importantly, mesothelioma patients on Alimta had a median survival of more than a year and 7 months compared to about 10 months for those treated with the Gemzar combination.

Although both types of chemotherapy had the potential to cause serious side effects in the mesothelioma patients taking them, Alimta appeared to come out ahead of Gemzar in this area, too. The researchers report that both drug combinations caused thrombocytopenia, an abnormally low number of platelets, and neutropenia, a drop in neutrophil white blood cells, but that both problems were “more frequent and severe” with Gemzar treatment.

In the conclusion to their published summary, Dr. Shukuya and his colleagues write, “Cisplatin plus pemetrexed (Alimta) may be superior and should continue to be the standard front-line chemotherapeutic regimen for inoperable malignant pleural mesothelioma.”

Alimta was developed by a Princeton scientist who claims to have conceived the idea while studying chemical compounds known as heterocyclic compounds in the iridescent wings of butterflies. It was approved as a first-line mesothelioma treatment in 2008. Both Alimta and Gemzar are marketed by Eli Lilly and Company.


Shukuya, T, “Comparison of cisplatin plus pemetrexed and cisplatin plus gemcitabine for the treatment of malignant pleural mesothelioma in Japanese patients”, March 2014, Respiratory Investigations, pp. 101-106. http://www.ncbi.nlm.nih.gov/pubmed/24636265

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