Phase II trial of mta (LY231514) in patients (PTS) with non-small cell lung cancer (NSCLC) who relapsed after previous platinum or non-platinum chemotherapy

Pemetrexed (Alimta, LY231514) demonstrates clinical activity in chemonaive patients with cervical cancer in a phase II single-agent trial

The objective of this study was to determine the response rate in chemonaive patients with inoperable, locally advanced, recurrent, or metastatic cervical cancer treated with pemetrexed (Alimta, LY231514), a multitargeted antifolate. The patients were treated with either 500 mg/m(2) (11 patients) or 600 mg/m(2) (24 patients) of pemetrexed, administered as a 10-min infusion on day 1 of a 21-day cycle. Patients receiving 500 mg/m(2) dose also received 5 mg/day oral folic acid supplementation beginning 2 days prior and ending on day 3 of each cycle. Of the 34 patients evaluable for efficacy, six patients (18%) had partial response, with median response duration of 3.8 months (range, 3.3-6.6 months). Twenty-four patients (71%) had stable disease, one patient (3%) had progressive disease, and three patients could not be assessed. Median overall survival was 15.2 months (range, 2.9-35.3+ months). Grade 4 hematologic toxicities consisted of neutropenia (37%), leukopenia (9%), anemia (6%), and thrombocytopenia (3%). One patient died of hypotensive shock associated with frank rectal hemorrhage that was considered to be related to the study drug. We conclude that pemetrexed therapy showed moderate activity, similar to other active agents, in the treatment of locally advanced or metastatic cervical cancer.

Pemetrexed in thoracic cancer

Both lung cancer and mesothelioma are malignancies with increasing incidence, and both are primarily due to inhalation of an external carcinogen. The occurence of both diseases is expected to rise worldwide, although a stabilisation and/or decrease may be anticipated in some developed countries. There are other common similarities to both cancers, including the median age of their patients, the advanced stage at presentation, the outcome and the treatments given. This review focuses on the available evidence of a novel antifolate agent, pemetrexed, in the treatment of both of these thoracic malignancies. Current status, persisting controversies and future developments are discussed.

Pemetrexed (ALIMTA), a novel multitargeted antineoplastic agent

Pemetrexed (ALIMTA, LY231514, MTA) is a novel antimetabolite that inhibits at least three enzymes involved in the folate pathway. These enzymes are thymidylate synthase, dihydrofolate reductase, and glycinamide ribonucleotide formyltransferase. Pemetrexed has demonstrated clinical activity in non-small cell lung cancer as well as in a broad array of other solid tumors, including mesothelioma, breast, colorectal, bladder, cervical, gastric and pancreatic cancer. In non-small cell lung cancer, single-agent activity has been documented in the first- and second-line settings in Phase II and Phase III trials. Promising activity has also been demonstrated when pemetrexed is combined with platinum compounds (cisplatin, carboplatin, and oxaliplatin), vinorelbine, and gemcitabine. Low level dietary supplement of folic acid and vitamin B12 has significantly decreased the mucosal and bone marrow toxicity of pemetrexed without compromising its antitumor effect.

Review of a promising new agent--pemetrexed disodium

Pemetrexed disodium (ALIMTa, [pemetrexed], LY231514; Eli Lilly and Company; Indianapolis, IN), a novel antifolate antimetabolite with multiple enzyme targets involved in both pyrimidine and purine synthesis, has entered clinical trials due to its favorable pleclinical profile. Many studies utilizing the drug, as a single or combination agent, are currently ongoing, including Phase III trials in mesothelioma, nonsmall cell lung carcinoma (NSCLC) and pancreatic cancer. Promising feasibility and activity data have been obtained with pemetrexed in combination with platinum compounds and gemcitabine. The supplementation with daily oral folate could reduce the incidence of hematologic toxicities while preserving the antitumor activity of pemetrexed.

Incorporation of pemetrexed (Alimta) into the treatment of non-small cell lung cancer (thoracic tumors)

Lung cancer is the leading cause of cancer death in the United States and throughout the world. The overall 5-year survival rate for lung cancer is dismal: 14% in the United States and even lower in other parts of the world. Recent developments in the armamentarium of chemotherapeutic agents for lung cancer have shown that two-drug combinations improve survival, relieve symptoms, and improve quality of life; however, complete response rates are still approximately 1% in stage IV disease and less than 20% of advanced stage patients survive 2 years. Therefore, improved therapeutic agents that increase efficacy are sorely needed. Most lung cancers overexpress thymidylate synthase and a variety of genes involved in cell cycle regulation. Previous studies have shown that some inhibitors of DNA synthesis (eg, gemcitabine) can improve the survival of advanced lung cancer patients, especially when combined with other agents such as cisplatin. The multitargeted antifolate, pemetrexed (Alimta; Eli Lilly and Co, Indianapolis, IN) was developed because it inhibits multiple enzymes involved in DNA synthesis including thymidylate synthase, dihydrofolate reductase, and glycinamide ribonucleotide formyl transferase. The early studies of pemetrexed showed that the important dose-limiting toxicities were myelosuppression, mucositis, and diarrhea, all of which are common with any antimetabolite. Subsequent studies described in this article will show that these toxicities can be significantly reduced by the use of vitamin supplementation with folate and B12, and that pemetrexed has considerable activity in non-small cell lung cancer and mesothelioma.

ALIMTA (pemetrexed disodium, LY231514, MTA): clinical experience in non-small cell lung cancer

ALIMTA is a novel, multi-targeted antifolate which inhibits several enzymes of the folate pathways and it has demonstrated a broad spectrum of clinical activity in multiple tumor types, including colorectal, breast, non-small cell lung cancer (NSCLC), pancreatic, head and neck, bladder and cervical cancers. ALIMTA has been tested in different patient populations, including those who have received no prior chemotherapy, those who have relapsed following prior platinum-containing therapy, and those who have relapsed following prior chemotherapy without platinum. In every group was demonstrated an activity comparable to currently used new drugs. ALIMTA was also studied in association with cisplatin in chemotherapy-naive patients and the overall response rate is comparable to other current combination regimens. From December 1999, an amendment has been made to all studies to add vitamin supplementation to reduce toxicity and early indications are that the frequency of serious toxicities resulting from ALIMTA treatment has been reduced. On the basis of the results of the studies reviewed, it is clear that ALIMTA is emerging as a new drug in the management of NSCLC.

Pemetrexed disodium: a novel antifolate clinically active against multiple solid tumors

Pemetrexed disodium (ALIMTA), "pemetrexed") is a novel, multi-targeted antifolate that has demonstrated promising clinical activity in a wide variety of solid tumors, including non-small cell lung, breast, mesothelioma, colorectal, pancreatic, gastric, bladder, cervix, and head and neck. Pemetrexed inhibits multiple folate-dependent enzymes involved in both purine and pyrimidine synthesis including thymidylate synthase, dihydrofolate reductase, glycinamide ribonucleotide formyltransferase, and aminoimidazole carboxamide ribonucleotide formyltransferase. As a single agent, pemetrexed exhibits a moderate toxicity profile at a dose of 500 mg/m(2) by 10-minute infusion once every 21 days with myelosuppression being the dose-limiting toxicity. Folic acid added to the diet in preclinical studies reduced toxicities while maintaining antitumor activity. Based on this observation and clinical toxicities, folic acid and vitamin B(12) dietary supplementation has been recently introduced into all ongoing trials. Studies combining pemetrexed with other active chemotherapeutic agents demonstrate that these combination therapies may become important treatment regimens in a variety of cancer types. Currently, pemetrexed phase III trials are ongoing in mesothelioma and non-small cell lung cancer with future trials planned to explore this unique multitargeted antifolate.

Pemetrexed: a multitargeted antifolate agent with promising activity in solid tumors

Pemetrexed disodium (ALIMTA, LY231514 (MTA)) is a novel multitargeted antifolate, that inhibits at least three enzymes involved in folate metabolism and DNA synthesis. These enzymes are thymidylate synthase, dihydrofolate reductase, and glycinamide ribonucleotide formyltransferase. This agent has shown broad antitumor activity in phase II trials in a wide variety of solid tumors, including non-small cell lung cancer, breast, colon, pancreas, bladder, head and neck, and cervical carcinomas, and is undergoing randomized phase III studies. MTA has also shown promising activity in a broad range of tumors in combination with other active agents such as gemcitabine and cisplatin. The clinical pharmacology, toxicity and clinical activity of MTA are reviewed in this report.