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

Long Term Peritoneal Mesothelioma Survival with NIPEC - A new report suggests that long term peritoneal mesothelioma survival may be possible with a treatment called NIPEC and the drug paclitaxel.  NIPEC stands for normothermic intraperitoneal chemotherapy. It is similar to the heated chemotherapy that many peritoneal mesothelioma patients now get. But NIPEC is delivered through a catheter over time and at room temperature.  The new article details the long term peritoneal mesothelioma survival of six patients on NIPEC with paclitaxel. It comes from one the nation’s leading experts in this form of mesothelioma, Paul Sugarbaker, MD.  Even though the sample size is small, Dr. Sugarbaker says the results are impressive enough to warrant further study.  HIPEC and Mesothelioma Treatment Peritoneal mesothelioma accounts for about 20 percent of mesothelioma … Continue reading Long Term Peritoneal Mesothelioma Survival with NIPEC »

Second-Line Mesothelioma Treatment with Ramucirumab - A combination of ramucirumab (CYRAMZA) and gemcitabine creates a promising second-line mesothelioma treatment. New research shows the combination nearly doubled survival in a group of patients whose tumors kept growing with standard therapy.  Italian researchers shared their findings at the virtual annual meeting of ASCO. ASCO is one of the largest gatherings of cancer doctors in the US. First-Line Mesothelioma Treatment Failure For most mesothelioma patients, chemotherapy with Alimta is the first-line treatment. This does keep the cancer in check for some patients. But after a while, mesothelioma tumors almost always come back. Chemotherapy only extends survival by about four months.  Doctors have tested many different approaches to second-line mesothelioma treatment.  Some of the therapies tested are: Additional rounds of … Continue reading Second-Line Mesothelioma Treatment with Ramucirumab »

Immunotherapy with Durvalumab: Record Survival in Inoperable Mesothelioma - There is new evidence that the immunotherapy drug durvalumab may make chemotherapy more effective for people with inoperable pleural mesothelioma. Researchers recently achieved record mesothelioma survival times with this combination. Mesothelioma is a rare cancer with a poor prognosis. Surgery can sometimes help if it is caught early. But only a small percentage of patients are candidates for mesothelioma surgery. Most have chemotherapy, which is only moderately effective.  But new research presented to the nation’s largest gathering of cancer doctors shows the immunotherapy drug durvalumab may help.  Doctors at Johns Hopkins combined durvalumab with standard mesothelioma chemotherapy. Study participants lived an average of 8 months longer than is typical with this disease.  If further studies confirm the benefit, it could … Continue reading Immunotherapy with Durvalumab: Record Survival in Inoperable Mesothelioma »

Chemoperfusion Treatment for Mesothelioma: Chemo Without the Side Effects? - New research suggests that chemoperfusion treatment for mesothelioma may buy patients more time without the side effects of traditional chemotherapy.  Chemoperfusion treatment involves injecting cancer-killing drugs directly into the vessels that feed a pleural mesothelioma tumor.  The research was presented during a virtual session of the Society of Interventional Radiology’s annual meeting. Researchers showed how this novel approach could improve quality of life for mesothelioma patients.  Limitations of Chemotherapy Pleural mesothelioma is a rare cancer with few treatment options. Most mesothelioma patients start with chemotherapy. Alimta (pemetrexed) is the primary chemotherapy drug for mesothelioma.  But chemotherapy has drawbacks that chemoperfusion treatment for mesothelioma might avoid.  Conventional chemotherapy circulates drugs throughout the body. That means that normal cells can absorb them … Continue reading Chemoperfusion Treatment for Mesothelioma: Chemo Without the Side Effects? »

Predicting Kidney Damage from Chemotherapy for Mesothelioma - It may be possible to predict which mesothelioma patients are at risk for kidney damage from chemotherapy and take steps to prevent it.  Japanese cancer researchers have linked a protein called megalin to cisplatin-related nephrotoxicity.  Cisplatin is one of the main drugs used to treat mesothelioma. The researchers say people with more megalin in their urine are more likely to have kidney damage from chemotherapy with cisplatin.  Kidney Damage is a Risk of Chemotherapy Malignant mesothelioma is a rare cancer with no cure. Although scientists are working on other options, chemotherapy is the main treatment for mesothelioma. Most patients have a combination of Alimta (pemetrexed) and the platinum-based drug cisplatin. One of the biggest risks with cisplatin is kidney damage … Continue reading Predicting Kidney Damage from Chemotherapy for Mesothelioma »

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 »