MESOTHELIOMA DRUGS

Alimta / Pemetrexed

Alimta is a new cancer drug used to treat malignant pleural mesothelioma. Alimta is given with cisplatin, another anti-cancer medicine. Alimta works by blocking specific enzymes thought to play a role in the rapid growth of these lung tumors. While Alimta is not a cure for malignant pleural mesothelioma in clinical trials patients who were treated with Alimta and cisplatin had a median survival of 12.1 months compared to 9.3 months for patients treated with cisplatin alone.

Alimta is given intravenously (into a vein), about every 21 days. Cisplatin is then infused about 30 minutes after Alimta treatment. To lower the chances of side effects with Alimta, it is necessary to take folic acid and vitamin B12 before, during, and after treatment.

To help your doctor decide if Alimta is right for you, tell your doctor if you:

• plan to become pregnant, or if you are pregnant, might be pregnant, or do not use effective birth control, because Alimta may harm your unborn baby.
• have kidney problems.
• are taking other medicines, including prescription and non-prescription medicines, vitamins, and herbal supplements. Tell your doctor or health care provider if you are taking NSAIDs (nonsteroidal anti-inflammatory drugs). Ask your doctor or pharmacist if you are not sure, because there are many NSAID medicines

• stomach upset, including nausea and vomiting, and diarrhea
• a drop in white blood cells, increasing the risk of infection
• a drop in red blood cells (anemia), causing tiredness or shortness of breath
• a drop in platelets that results in bruising or bleeding
• tiredness
• mouth, throat, or lip sores
• loss of appetite
• rash

• Women should avoid becoming pregnant while being treated with Alimta because Alimta may cause harm to an unborn baby.
• Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) for at least 5 days before Alimta treatment, during the day of treatment, and for two days after treatment. If you are not sure if a drug you take is a NSAID, ask your doctor or pharmacist. There are many NSAID medicines that are prescription and over-the-counter.

AlimtaŽ/Cisplatin Combination Approved for Malignant Pleural Mesothelioma

AlimtaŽ (pemetrexed) in combination with cisplatin (PlatinolŽ) was recently approved by the United States Food and Drug Administration (FDA) for the treatment of inoperable malignant mesothelioma. AlimtaŽ/cisplatin is the first and only drug regimen proven to improve the duration of survival for patients with advanced malignant mesothelioma.

The trial that prompted FDA approval of the AlimtaŽ/cisplatin regimen for patients with malignant mesothelioma who are not eligible for surgery involved the direct comparison of the addition of AlimtaŽ to cisplatin, versus cisplatin alone. Patients treated with AlimtaŽ also received daily vitamin B12 injections and folic acid supplements, in order to reduce side effects. The trial included nearly 450 patients from 19 countries who had inoperable mesothelioma and were treated with either AlimtaŽ/cisplatin or cisplatin alone. Overall survival was increased by 30% in the group of patients treated with AlimtaŽ/cisplatin (21.1 months), compared to the group treated with cisplatin alone (9.3 months). Furthermore, one-year survival rates were 50.3% for patients treated with AlimtaŽ/cisplatin, compared with only 38% of patients treated with cisplatin alone. Lung function was also improved with in the group of patients treated with AlimtaŽ/cisplatin compared to those treated with cisplatin alone. Side effects associated with AlimtaŽ included low levels of blood cells, nausea, vomiting, diarrhea, pain, skin rash and fatigue.

Onconase

Onconase is a new chemotherapy drug that is being tested for efficacy in the treatment of mesothelioma. The drug with widespread acceptance for use in treatment is Doxorubicin. The benefit of Onconase over Doxorubicin is that Onconase is relatively free of the crippling side effects of traditional chemotherapy. The clinical trials for this drug are being held at several sites around the country.

Gemcitabine

Gemcitabine is a new chemotherapy drug for the treatment of mesothelioma. It is currently in clinical trials with many mesothelioma patients in combination with Cisplatin, Alimta and Epirubicin.

It is believed to be the most effective drug in treatment of pancreatic cancer and mesothelioma patients have shown good responses. Gemcitabine is a clear liquid administered by an infusion that usually takes no longer than half an hour. It may also be given through a central line into a vein near the collarbone.

The method and schedule by which this drug is administration is determined by the type and extent of the cancer and is a decision made by the medical oncologist. Generally, it is given once a week for as long as the patient responds to the drug. The degree and severity of the side effects depend largely on the dosage administered.

Side Effects:

Some patients develop a temporary reduction in bone marrow function. This is generally mild but can occasionally be more severe. If it does occur, it can result in anemia, risk of bruising or bleeding and an increased risk of infection. If a patient develops a temporary reduction in bone marrow function, it will typically begin about 7 days after the treatment has been given and will usually reach its lowest point at about 10-14 days after the chemotherapy. Afterwards, the patient's blood count will increase steadily and will usually return to normal within 21 days.

Some patients will experience illness a few hours after treatment, but generally the symptoms are not severe, are treatable by anti-sickness drugs and will dissipate after a day or so. If more severe symptoms are experienced the patient should get in touch with his or her doctor straight away. For instance, patients who develop a high temperature (above 100.5F), suffer unexplained bruising or bleeding, or suddenly feel unwell (regardless of their temperature), are advised to contact their doctor or hospital immediately.

Some patients will experience a reduction in appetite but generally this is mild and only lasts a day or so. Some patients will experience a temporary effect on their liver and/or kidney functions, but these effects are unlikely to be noticed by the patient, and both liver and kidney will generally return to normal at the end of treatment. Gemcitabine may cause a mild treatable rash in some patients but again this symptom is temporary.

Some patients will develop fluid retention that will appear in the form of swelling ankles or breathlessness. In these instances a doctor should be notified immediately.

Less commonly patients will develop mouth sores and ulcers which are easily treated by prescribed medicines. Diarrhea is developed by 19% of patients receiving Gemcitabine but can also be easily controlled with medicine. Hair loss is seen in about 15% of patients but more commonly the patients hair only thins temporarily returning to its natural fullness once treatment is finished. It is imperative that patients relay any side effects or problems to their medical oncologists.