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Alimta is the brand name of the anticancer chemotherapy drug pemetrexed. Alimta is used to treat malignant pleural mesothelioma and other types of cancer. This chemotherapy drug is known for not only prolonging the lives of some mesothelioma patients but also improving the quality of their lives. It is considered the standard treatment for mesothelioma when given in combination with another chemotherapy drug, cisplatin.

Fact-Checked and Updated by: Jenna Tozzi, RN

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What Is Alimta?

Alimta (pemetrexed) is an anticancer chemotherapy drug manufactured by Eli Lilly and Company.

Did You Know?

The U.S. Food and Drug Administration (FDA) approved Alimta and cisplatin, another chemotherapy drug, as the first widely excepted chemotherapy regimen for mesothelioma in 2004.

Specifically, the FDA approved Alimta to treat pleural mesothelioma and non-small cell lung cancer (NSCLC) in tandem with cisplatin. The agency approved the chemotherapy combination for patients who had cancer that could not be treated by surgery.

The FDA approved Alimta for use as a first-line single-agent chemotherapy treatment in 2008.

Sometimes Alimta is used as a secondary therapy and prescribed when the first line of chemotherapy is unsuccessful. Patients who have entered remission may also receive Alimta as a maintenance treatment to extend their remission.

Today, Alimta is considered the most promising chemotherapy drug to treat mesothelioma and is used as the standard baseline comparison to other chemotherapy drugs in clinical trials.

However, Alimta has its drawbacks. For example, Alimta does not work for all patients, and some patients who do respond to the drug have shorter overall survival rates than others.

Scientists are studying why Alimta works in some patients and not others and looking at how mesothelioma cells become resistant to chemotherapy.

Alimta and other chemotherapy drugs often play a key role in helping mesothelioma patients live longer. Some patients even became long-term survivors thanks to chemotherapy. Find out more in our Free Survivors Guide. 

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How Is Alimta Administered?

Alimta chemotherapy is administered to mesothelioma patients through intravenous (IV) injection. The recommended dosage is 500 mg. Each dose is typically given over a 10-15 minute period.

To boost its effectiveness, Alimta is regularly administered with other chemotherapy drugs such as cisplatin.

Alimta Treatment Update

Alimta treatment usually follows a 3-week or 21-day cycle. The initial treatment includes 1 dose of Alimta and is often followed 30 minutes later by a dose of cisplatin, which is administered over 2 hours. This cycle is repeated every 3 weeks and lasts as long as the mesothelioma health care specialist recommends.

However, researchers are studying whether adjustments to the treatment schedule for Alimta and cisplatin could improve outcomes for mesothelioma patients.

Swiss researchers found that pleural mesothelioma patients who received Alimta 48 hours prior to cisplatin had “significantly reduced long-term cell growth.” The results were published in the International Journal of Molecular Sciences in October 2022.

Patients who get Alimta infusions undergo blood tests before and during treatment to monitor liver and kidney function and blood cell levels.

How Does Alimta Treat Mesothelioma?

Alimta is an antifolate antimetabolite. Antifolates are antineoplastic agents that stop cells from using folate, which helps the cells produce DNA.

Simply put, Alimta blocks the enzymes cancer cells need to grow and repair, which slows or stops the spread of a patient’s cancer.

Mesothelioma doctors can tell you more about how Alimta works and if it may be able to help you. Connect with specialists using our Free Doctor Match.

Alimta Drug Combinations

Alimta can be administered on its own or in conjunction with other mesothelioma chemotherapy drugs.

Alimta and cisplatin have been combined since the FDA approved Alimta in 2004, and this pairing remains the most common combination. Alimta and cisplatin are considered the most effective pleural mesothelioma chemotherapy treatments for patients who are not eligible for surgery.

Past clinical trials have revealed that the life expectancy of patients who receive the combination of Alimta and cisplatin is longer than those who do not undergo chemotherapy or those who only receive cisplatin.

Doctors sometimes pair Alimta with pembrolizumab (Keytruda), a type of immunotherapy drug. In cases of advanced NSCLC, Alimta and carboplatin are commonly administered for first-line treatment.

Current Alimta Clinical Trials

Scientists are conducting mesothelioma research in labs around the world to find more effective drug combinations to treat this rare but aggressive and incurable disease.

A doctor reviews information with a patient.

Recently, the National Comprehensive Cancer Network (NCCN) amended its first-line treatment recommendation and included the drug bevacizumab (Avastin) to be used in combination with Alimta and cisplatin. Bevacizumab is an FDA-approved antibody that targets and blocks the growth of blood vessels that cancer cells need to grow.

A recent Japanese study found that the combination of Alimta and cisplatin can also be successful in treating peritoneal mesothelioma.

Another notable mesothelioma clinical trial is being sponsored by the National Cancer Institute (NCI). This study is testing the combination of methoxyamine (a drug that improves the effectiveness of chemotherapy) with Alimta and cisplatin in patients whose mesothelioma progressed after getting chemotherapy before.

Researchers are also testing what happens when IMRT (intensity-modulated radiotherapy) is added to a treatment regimen of Alimta coupled with platinum-based therapy for patients with pleural mesothelioma.

Alimta is also currently available as a standard mesothelioma treatment outside of clinical trials. Chemotherapy drugs such as Alimta can play a big part in helping mesothelioma patients survive for many years with this cancer. See how in our Free Survivors Guide.

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Alimta Side Effects

As with all chemotherapy drugs, mesothelioma cancer patients usually experience side effects after receiving Alimta. Side effects vary and typically range from mild to moderate in nature.

Some common side effects of Alimta are:

  • Constipation
  • Loss of appetite
  • Low blood platelet count (thrombocytopenia)
  • Low red blood cell count (anemia)
  • Low white blood cell count (neutropenia)
  • Mouth sores
  • Nausea
  • Skin rash
  • Sore throat
  • Tiredness
  • Vomiting

Alimta can cause more serious side effects, including kidney problems and lung problems (pneumonitis).

Some Alimta patients experience radiation recall, which is a skin reaction in patients who have undergone radiation treatment before. Radiation recall appears as swelling, blistering, or redness of the skin similar to sunburn in the area that has been previously exposed to radiation.

Patients should tell a member of their oncology team if they have any of these severe side effects. They should also talk to their team about any over-the-counter drugs or supplements they are taking to prevent dangerous drug interactions. Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs), for example, can make Alimta side effects worse.

Prior to treatment, patients are typically given a Vitamin B12 injection, folic acid tablets, and other supplements to help with side effects. Many patients take corticosteroids such as dexamethasone to help prevent skin reactions.

Your cancer care team will let you know the treatment approach that is right for you.

Find out about how chemotherapy and other treatment plans helped 7 mesothelioma patients achieve long-term survival in our Free Survivors Guide.

Alimta for Mesothelioma FAQs

Is Alimta chemo or immunotherapy?

Alimta, which is the brand name for pemetrexed, is a type of chemotherapy drug used to treat mesothelioma and other types of cancer.

What does Alimta do?

Alimta is a type of chemotherapy drug that prevents cancer cells from using folate, a B vitamin that helps the cells make and repair DNA. This stops the cancer cells from growing and multiplying.

Why is B12 given with Alimta?

Vitamin B12 is given with Alimta to lower the risk of severe side effects. Specifically, B12 lowers the risk of a decrease in bone marrow and blood cells, which can cause anemia, bleeding, and infection.

Patients typically get a vitamin B12 injection one week before their first dose of Alimta and then every three cycles.

Patients also take folic acid and a medication called corticosteroid.

Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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  1. NCBI. “First-line chemotherapy with pemetrexed plus cisplatin for malignant peritoneal mesothelioma.”
    Retrieved from Accessed December 15, 2022.

  2. ClinicalTrials.Gov. “Methoxyamine, Cisplatin, and Pemetrexed Disodium in Treating Patients With Advanced Solid Tumors or Mesothelioma That Cannot Be Removed by Surgery or Mesothelioma That Is Refractory to Pemetrexed Disodium and Cisplatin or Carboplatin” Retrieved from: Accessed on December 15, 2022.

  3. ClinicalTrials.Gov. “Study of Cytoreductive Surgery and Hyperthermic Intraoperative Chemotherapy With Pemetrexed and Cisplatin for Malignant Pleural Mesotheliomas.” Retrieved from: Accessed December 15, 2022.

  4. Eli Lilly. “Patient Information Alimta.” Retrieved from: Accessed on December 15, 2022.

  5. Cancer Research UK. “Pemetrexed (Alimta).” Retrieved from: Accessed on December 2022.

  6. Mesothelioma Applied Research Foundation. “MesoTV: Clinical trial assessing the addition of IMRT to pemetrexed (Alimta)/platinum based therapy with Andreas Rimner, MD. Retrieved from: Accessed on December 15, 2022.

  7. Meothelioma Applied Research Foundation. “Can pemetrexed’s (Alimta) effectiveness in mesothelioma treatment be improved?” Retrieved from: Accessed on December 15, 2022.

  8. Karatkevich D, Deng H, Gao Y, Flint E, Peng R-W, Schmid RA, Dorn P, Marti TM. “Schedule-Dependent Treatment Increases Chemotherapy Efficacy in Malignant Pleural Mesothelioma.” International Journal of Molecular Sciences. 2022; 23(19):11949. Retrieved from: Accessed on December 15, 2022.

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