Pemetrexed (Alimta, MTA, multitargeted antifolate, LY231514) for malignant pleural mesothelioma

Regimens with antimetabolites such as gemcitabine administered alone or in combination with cisplatin have shown promising phase II study data. Accordingly, antifolate agents are of considerable interest. Pemetrexed (Alimta; Eli Lilly and Company, Indianapolis, IN), a folate-based inhibitor of thymidylate synthase., is currently under phase III investigation. The Evaluation of Mesothelioma in a Phase III Trail of Pemetrexed with Cisplatin (EMPHACIS) trial is the first phase III randomized study in mesothelioma with survival as the primary end point; it showed statistically significant superiority of the pemetrexed/cisplatin combination over cisplatin low-dose folic acid and vitamin B12 supplementation significantly reduced the toxicity observed with the use of pemetrexed/cisplatin will soon be recommended for malignant pleural mesothelioma as first-line standard chemotherapy.