While doctors might choose from an assortment of available medicines to care for malignant mesothelioma patients, a combination treatment with two chemotherapy drugs—pemetrexed disodium (marketed as Alimta) and cisplatin (marketed as Platinol)—is a mainstay. The two drugs are typically used in patients when surgery is not an option.
Pemetrexed received approval from the federal Food and Drug Administration (FDA) in 2004 for the treatment of malignant pleural mesothelioma, a cancer of the chest cavity lining, after a randomized clinical trial showed that the drug, given with cisplatin, extended patients’ average survival time longer than cisplatin alone.
As the first drug shown to be effective against pleural mesothelioma, pemetrexed received priority review from the FDA. As with most chemotherapy treatments, mesothelioma patients are vulnerable to experiencing side effects from the combination of pemextrexed and cisplatin. In more than half the patients in the clinical trial, the treatment suppressed bone marrow function, which might lead to low counts of white blood cells, the body’s infection fighters. It’s important that mesothelioma patients on pemetrexed and cisplatin tell their doctors immediately about any signs of infection, such as fever or chills or mouth ulcers. Vitamin B-12 and folic acid are administered with pemetrexed to reduce the risk of a low white cell count, as well as the likelihood of other side effects. Cisplatin and pemetrexed also lowered red blood cell counts in about one-quarter of the mesothelioma patients in the clinical trial. This condition, known as anemia, can cause fatigue. Medicines are available to treat both low white and low red blood cell counts. Also, research has shown that moderate exercise can help reduce cancer patients’ fatigue, and perhaps lessen pain.
Mesothelioma patients on pemetrexed could also experience a drop in their platelet count. Platelets help the blood to clot, and patients with reduced levels of platelets should report any signs of bleeding. These patients also might be asked to take precautions to avoid even minor injuries that might cause bleeding, such as using a soft toothbrush to prevent gum bleeding. Nausea and vomiting are very common side effects of the pemetrexed-cisplatin combination; fortunately, effective anti-nausea medicines can be prescribed. Patients should promptly tell their doctors about those symptoms—as well as rash, diarrhea, constipation, sore or gritty eyes and other health concerns. It’s important that mesothelioma patients keep their health care teams fully informed of side effects and avoid choosing over-the-counter treatments without medical consultation.