Chemotherapy

What is Chemotherapy?

Chemotherapy is a group of toxic drugs that kill cells (mesothelioma, other cancers, and healthy cells) by damaging their DNA. Chemotherapy is a cytotoxic therapy, meaning it kills cells. Chemo drugs target rapidly growing cancer cells, but they can also affect healthy cells that grow rapidly such as blood cells. The effect of these drugs on both cancer and normal cells often causes chemo side effects.

Alimta (Pemetrexed) and Cisplatin

As of this writing, the only FDA approved chemotherapy for mesothelioma is a combination of Alimta (pemetrexed) and cisplatin. In February 2004, the Food and Drug Administration approved pemetrexed for the treatment of malignant pleural mesothelioma in combination with cisplatin for patients whose disease is either inoperable or who are not otherwise candidates for curative surgery. Patients who take this chemo regimen are often prescribed folic acid and vitamin B12 supplement to help reduce side effects from the chemotherpay. Patients are usually prescribed corticosteroids to reduce the risk of skin rashes as well.

The recommended dose of pemetrexed is 500 mg/m administered as an intravenous infusion over 10 minutes on day 1 of each 21-day cycle together with cisplatin at a dose of 75 mg/m infused over 2 hours beginning 30 minutes after the pemetrexed infusion.

The Clinical Trial that Approved Alimta (Pemetrexed) and Cisplatin

There was one key clinical trial that led to the FDA approval of this regimen for mesothelioma. Two hundred twenty-six pleural mesothelioma patients were randomized to receive pemetrexed and cisplatin, while 222 patients were randomized to receive cisplatin alone. The primary study end point was survival. Median survival times were 12.1 months for the pemetrexed plus cisplatin treatment group and 9.3 months for the cisplatin alone group.

Median time to progression (regrowth of tumor) was longer in the pemetrexed/cisplatin arm of the study, 5.7 months versus 3.9 months. This means that the mesothelioma patients who received both drugs had their tumors return a median of 1.8 months longer versus those who only got one drug.

Like most chemo drugs, pemetrexed kills blood cells so the most common adverse events were neutropenia, fatigue, leukopenia, nausea, dyspnea, and vomiting.

On February 4, 2004, pemetrexed was approved by the FDA in combination with cisplatin for the treatment of patients with malignant pleural mesothelioma whose disease is inoperable or who are otherwise not candidates for curative surgery.

Related Posts

Second Line Mesothelioma Treatment Shot Down in New Study - Italian researchers say there is good news and bad news about a proposed second line mesothelioma treatment.  The good news is that the treatment did not cause major side effects in the patients who tried it. The bad news is that it also did not help them live any longer.  The treatment is a mixture of gemcitabine and imatinib. Animal studies suggested that the combination might improve mesothelioma survival.  The newly-published study shows the second line mesothelioma treatment did help control the disease in most patients. But the 23 patients who tried it only lived for a median of 5.7 months. That was not enough for doctors to recommend the combination. Mesothelioma Chemotherapy and Survival The most common first line … Continue reading Second Line Mesothelioma Treatment Shot Down in New Study »

Injectable Pemetrexed for Mesothelioma Now Available for the First Time - The FDA has cleared injectable pemetrexed for mesothelioma after two drug companies settled a patent dispute over the medication in December. Until now, the chemotherapy drug pemetrexed has only been available for infusion. In this form, it is called Alimta and is distributed by Eli Lilly.  But New Jersey-based Eagle Pharmaceuticals wanted to develop a form of injectable pemetrexed for mesothelioma. They received tentative approval for the drug in 2018, but it was not until the patent issue was settled that the final approval was granted.  The drug may shorten the duration of treatment for some patients with malignant mesothelioma.  Pemetrexed the Primary Mesothelioma Treatment Malignant mesothelioma is an intractable cancer that grows on the membranes around internal organs. Patients … Continue reading Injectable Pemetrexed for Mesothelioma Now Available for the First Time »

Drug May help Mesothelioma Patients Overcome Resistance to Chemotherapy - A newly-identified compound might eventually help mesothelioma patients overcome resistance to chemotherapy.  Chemotherapy resistance is one of the main reasons that mesothelioma treatments fail.  But researchers at Duke University and the Massachusetts Institute of Technology have identified a compound that combats resistance to chemotherapy with cisplatin.  Cisplatin is one of the primary drugs in first-line chemotherapy for mesothelioma. If mesothelioma cells can be sensitized to it, patients may have better outcomes.   First-Line Treatment for Malignant Mesothelioma Pleural mesothelioma is a cancer that grows on the lining around the lungs. Peritoneal mesothelioma starts on the lining of the abdomen. Both types of mesothelioma are caused by asbestos exposure.  Chemotherapy with cisplatin and pemetrexed (Alimta) is the treatment that doctors usually try … Continue reading Drug May help Mesothelioma Patients Overcome Resistance to Chemotherapy »

Supplements During Chemotherapy May Work Against Mesothelioma Treatment - A new study suggests that it could be risky to take supplements during chemotherapy for mesothelioma and other cancers.  The study took place at the Roswell Park Comprehensive Cancer Center in Buffalo, New York. It focused on more than 1,100  breast cancer patients. It found that patients who took certain antioxidant supplements during chemotherapy had worse outcomes than those who did not.  The study’s authors say antioxidants undermine one of the main jobs of chemotherapy drugs – to create oxidative stress in cancer cells. Chemotherapy is the primary first-line treatment for malignant mesothelioma and many other cancers.  Why Avoid Antioxidant Supplements During Chemotherapy? Antioxidants are compounds found in many fruits and vegetables. Vitamins A, C, E, and B12 are examples … Continue reading Supplements During Chemotherapy May Work Against Mesothelioma Treatment »

Peritoneal Mesothelioma Surgery with HIPEC Can Trigger Blood Cell Problems - More than half of patients who have peritoneal mesothelioma surgery with HIPEC develop problems with their blood cells afterward. That’s the finding of a team of cancer researchers from Singapore.  The group analyzed 15 years worth of data on peritoneal mesothelioma surgery outcomes. They found that, even though the procedure saves lives, it can be risky.  Older patients and those who had prior chemotherapy were most likely to develop hematological toxicities after peritoneal mesothelioma surgery.  Hematological Toxicities and Mesothelioma Treatment Hematological toxicities are problems with the cells that make up the blood. This can include white blood cells, red blood cells, platelets, and proteins involved in bleeding and clotting.  Several drugs that kill mesothelioma cells can cause blood cell problems. … Continue reading Peritoneal Mesothelioma Surgery with HIPEC Can Trigger Blood Cell Problems »

Mesothelioma Tumor Response to Nivolumab Detailed in New Case Study - An Indian woman in still alive two years after a mesothelioma diagnosis thanks to a remarkable mesothelioma tumor response to nivolumab. Nivolumab is sold under the brand name Opdivo. It is a type of immunotherapy. Nivolumab is sometimes used for lung cancer that progresses after chemotherapy. A hospital in Mumbai tried nivolumab on a pleural mesothelioma patient after several types of chemotherapy did not work. Doctors say the mesothelioma tumor response to nivolumab was so great that the patient no longer needed supplemental oxygen.  Opdivo in Mesothelioma Treatment Opdivo is not FDA-approved for mesothelioma treatment. Only Alimta (pemetrexed) holds that designation. But pleural mesothelioma grows quickly and is hard to treat. Even the gold standard therapies often do not work … Continue reading Mesothelioma Tumor Response to Nivolumab Detailed in New Case Study »

Effect of Chemotherapy on Immunotherapy for Mesothelioma - Belgian scientists say they are still not sure about the effect of chemotherapy on immunotherapy for mesothelioma. They reached that conclusion after testing several different chemotherapy drugs on mesothelioma cells in the lab. The combination of chemotherapy and immunotherapy is “chemoimmunotherapy”. It aims to harness the unique powers of each treatment approach. A meta-analysis last May called chemoimmunotherapy the “next frontier” in mesothelioma treatment.  But the new Belgian study on the effect of chemotherapy on immunotherapy highlights how much doctors still do not know about the combo. Immune Checkpoints Are the Key When it is working properly, the immune system is supposed to find and kill cancer cells before they become mesothelioma tumors. But mesothelioma cells can hide from the … Continue reading Effect of Chemotherapy on Immunotherapy for Mesothelioma »

Isolated Thoracic Perfusion for Mesothelioma Symptom Relief - A new study suggests that a treatment called isolated thoracic perfusion could help alleviate some of the worst symptoms of malignant pleural mesothelioma. Isolated thoracic perfusion is a method for circulating medicine in just one area of the body. When doctors circulated chemotherapy drugs in the chests of people with pleural mesothelioma, their symptoms went away for several months.  Now, the team says it is time to test the technique in a bigger pool of mesothelioma patients.  The Theory Behind ITP Pleural mesothelioma is a membrane cancer that occurs in the chest. Chemotherapy drugs like Alimta can be powerful weapons against pleural mesothelioma. But they can also damage healthy tissues.  When healthy tissues are damaged by chemotherapy, mesothelioma patients can … Continue reading Isolated Thoracic Perfusion for Mesothelioma Symptom Relief »

Unresectable Peritoneal Mesothelioma Becomes Operable After Bi-Directional Chemotherapy - French researchers have successfully operated on a man with unresectable peritoneal mesothelioma after treating him with bi-directional chemotherapy. Chemotherapy is the most common treatment for unresectable peritoneal mesothelioma. Most mesothelioma patients have chemotherapy by IV infusion. But some cancer centers now offer another chemotherapy delivery method. Intraperitoneal chemotherapy bypasses the bloodstream. It lets doctors put higher doses of cancer-killing medicine at the site of a tumor. The French team combined the two types of chemotherapy in one patient. It shrunk the patient’s unresectable peritoneal mesothelioma tumor enough to perform surgery.  Two Types of Mesothelioma Chemotherapy With IV chemotherapy, medicine travels to the tumor through the bloodstream. It is one way of treating unresectable peritoneal mesothelioma. One drawback of IV chemotherapy … Continue reading Unresectable Peritoneal Mesothelioma Becomes Operable After Bi-Directional Chemotherapy »

Cediranib for Mesothelioma: VEGF Inhibitor Fails Another Trial - Cediranib for mesothelioma appears to be ruled out by another failed clinical trial.  A new study led by MD Anderson researchers concludes that the VEGF inhibitor causes too many side effects for not enough survival benefit.  It is a blow to researchers hoping to use cediranib for mesothelioma patients on chemotherapy.  Cutting Off Tumor Blood Supply Cediranib is an oral drug made by AstraZeneca. It is part of a class of drugs called VEGF inhibitors. Vascular endothelial growth factor (VEGF) is a signal protein that stimulates blood vessel formation in tumors. Research shows that mesothelioma patients who have higher serum levels of VEGF have a lower chance of survival.  VEGF inhibitors like cediranib latch onto VEGF receptors inside mesothelioma cells. … Continue reading Cediranib for Mesothelioma: VEGF Inhibitor Fails Another Trial »