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Gemcitabine
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The chemotherapeutic drug gemcitabine is most often used to treat pancreatic, ovarian and breast cancers. Doctors also found success treating pleural and peritoneal mesothelioma and certain types of lung cancer. It's often used in combination with another chemotherapy drug.
Written by Karen Selby, RN | Medically Reviewed By Dr. Jeffrey Velotta | Edited By Walter Pacheco | Last Update: November 6, 2024
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Written by Karen Selby, RN | Medically Reviewed By Dr. Jeffrey Velotta | Edited By Walter Pacheco | Last Update: November 6, 2024
What Is Gemcitabine?
Gemcitabine is a chemotherapy drug. It blocks DNA replication in cancer cells to slow pleural mesothelioma. Scientists at Eli Lilly discovered it and marketed it as Gemzar for injection.
Before starting gemcitabine, patients must inform their doctor of any medications they take. This includes all prescriptions, vitamins, supplements, and OTC drugs.
Gemcitabine Information
| Brand Name | Gemzar |
| Alternate Names | Gemcitabine Hydrochloride |
| Manufacturer | Eli Lilly and Company |
| Dosage | 1250 mg/m² on days 1, 8 and 15 every four weeks |
| Administration Route | Intravenous |
| Active Ingredient | Gemcitabine |
| Drug Class | Antimetabolite |
| Medical Code | J9201 |
| Interacting Drug | Flu vaccine, adenovirus types 4 and 7 live vaccines, palifermin, tofacitinib, warfarin |
| Medical Studies | Transarterial Chemoperfusion: Cisplatin, Methotrexate, Gemcitabine for Unrescetable Pleural Mesothelioma |
| FDA Warning | Pulmonary toxicity, respiratory failure, bladder toxicity, liver damage, myelosuppression, fetal harm, radiation therapy toxicity, capillary leak syndrome, posterior reversible encephalopathy syndrome |
Patients with mesothelioma may do well on gemcitabine. This drug is often used for people who can’t tolerate platinum drugs, like cisplatin or carboplatin.
Treatment Using Gemcitabine for Mesothelioma
Gemcitabine chemotherapy is usually done on an outpatient basis. It’s given via IV. Treatment typically involves a trip to a doctor’s office, clinic or hospital. The procedure usually takes a few hours. The drug administration lasts about 30 minutes.
It’s usually given on various schedules. The most common is once a week for 3 weeks, then 1 week off. Your cancer doctor will set the best treatment length and dosage for you.
Gemcitabine, or Gemzar, is a chemotherapy drug for mesothelioma. It can be used alone or with platinum drugs. Gemcitabine is often more effective as a second- or third-line option after other treatment options have failed.
Dr. Jennifer M. Suga, medical oncologist at Kaiser Permanente Medical Center
The drug may be given alone or with another chemo agent or anti-cancer drugs. It may be used in first-line or second-line chemotherapy regimens for mesothelioma. The FDA has approved gemcitabine for breast, ovarian, pancreatic and non-small cell lung cancers.
First-line chemotherapy with gemcitabine often combines it with another drug, like cisplatin. This drug may be given as second-line chemo. It can be used alone or in combination, depending on the patient’s response to first-line chemo. Gemcitabine is used more in second-line chemo for mesothelioma than in first-line. This is because cisplatin and pemetrexed have better survival rates.
What Are the Benefits of Gemcitabine for Mesothelioma?
Pairing gemcitabine with other anti-cancer drugs improves outcomes for people with mesothelioma. Recent research on gemcitabine for mesothelioma combines it with immunotherapy, as well as with targeted and gene therapies.
Gemcitabine has helped many people with pleural mesothelioma. It eased symptoms like chest pain, cough and shortness of breath. It can also help delay cancer growth and progression for some patients. A study in the Journal of Thoracic Oncology found that gemcitabine could nearly double progression-free survival after first-line treatment.
Chemotherapy aims to slow or kill the rapidly growing cancer cells in the patient. However, those agents that are used can sometimes also kill rapid growing healthy cells. I always encourage patients to understand that there may be side effects, but not all the time.
Side Effects of Gemcitabine for Mesothelioma
The most common side effects of gemcitabine are nausea and flu-like symptoms. It also increases the risk of infection.
Chemotherapy drugs can harm the immune system. They kill specific immune cells. If you take gemcitabine for mesothelioma, avoid people who might be sick. They may have colds or other infections. A medical face mask may be worn to protect you from contact with germs.
Gemcitabine Side Effects
- Blood in urine, or particularly dark urine
- Change in kidney function
- Change in liver function
- Chest pain
- Confusion, balance impairment or impaired vision or speech
- Constipation or diarrhea
- Fever, chills and body aches (similar to symptoms of flu)
- Less frequent urination
- Nausea and vomiting
- Numbness or weakness, most often on one side of the body
- Pain or swelling at the location where gemcitabine was administered
- Sores or white patches inside the mouth
- Swelling in the ankles, feet or hands (edema)
- Tendency to bruise or bleed easily
Those with impaired liver or kidney function shouldn’t use gemcitabine. It can cause severe liver and kidney damage.
Gemcitabine and most chemotherapy drugs can also harm unborn babies. Pregnant women should discuss their options with their doctors.
Gemcitabine Research
Several phase II clinical trials have investigated gemcitabine’s effectiveness on mesothelioma. Some phase II trials report higher response or overall survival rates than others. Despite inconsistent results, the consensus is that the drug benefits people with mesothelioma.
An active 2024 clinical trial is testing a mix of gemcitabine and ramucirumab for mesothelioma. This is after disease progression on platinum and pemetrexed chemotherapy. Early results show ramucirumab plus gemcitabine is better than gemcitabine plus placebo. It improved overall survival and had a good safety profile.
The results [of a 2021 study] show that the addition of ramucirumab to gemcitabine can provide a notable improvement in overall survival. This combination could be a new option in this setting.
Past studies have tested variables such as prolonged low-dose administration vs. typical doses and length. A 6-hour low-dose was one of the longest reported times for chemotherapy and was more effective than 30-minute infusions. Another study combined gemcitabine and cisplatin, which shrank tumors more than 30%. However, mesothelioma expert Dr. Hedy Kindler led a trial testing a gemcitabine, cisplatin and bevacizumab combo with results not significant enough to warrant further study.
Studies continue to investigate the best ways to administer gemcitabine to treat mesothelioma. The drug may work better with other chemotherapy drugs, targeted therapies or nutrition. Trials are ongoing to improve outcomes for patients.
This Page Contains 11 Cited Articles
The sources on all content featured in The Mesothelioma Center at Asbestos.com include medical and scientific studies, peer-reviewed studies and other research documents from reputable organizations.
- ClinicalTrials.gov. (2024, April 1). Switch-Maintenance Gemcitabine After First-Line Chemotherapy In Patients With Malignant Pleural Mesothelioma. Retrieved from https://clinicaltrials.gov/study/NCT05660616
- Pinto, C. et al. (2021, October). Gemcitabine with or without ramucirumab as second-line treatment for malignant pleural mesothelioma (RAMES): a randomised, double-blind, placebo-controlled, phase 2 trial. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1470204521004046
- ASCO University. (2010). IFCT-GFPC-0701 MAPS trial, a multicenter randomized phase II/III trial of pemetrexed-cisplatin with or without bevacizumab in patients with malignant pleural mesothelioma. https://ascopubs.org/doi/abs/10.1200/jco.2010.28.15_suppl.7020
- Eli Lilly. (2013, Nov. 19). Gemzar. http://www.gemzar.com/Pages/index.aspx
- Kindler, H.L., Karrison, T.G., Gandara, D.R., Lu, C., Krug, L.M., Stevenson, J.P., Vokes, E.E. (2012). Multicenter, double-blind, placebo-controlled, randomized phase II trial of gemcitabine/cisplatin plus bevacizumab or placebo in patients with malignant mesothelioma. Journal of Clinical Oncology, 30(20): 2509-2515. doi: 10.1200/JCO.2011.41.5869
- Kindler, H.L. & Meerbeeck, J.P. (2002). The role of gemcitabine in the treatment of malignant mesothelioma. Seminars in Oncology, 29(1): 70-76. http://www.ncbi.nlm.nih.gov/pubmed/11836671/
- Simon, G.R., Verschraegen, C.F., Janne, P.A., Langer, P.A.,Dowlati, A., Gadgeel, S.M., Kindler, H.L. (2008). Pemetrexed plus gemcitabine as first-line chemotherapy for patients with peritoneal mesothelioma: final report of a phase II trial. Journal of Clinical Oncology, 26(21): 3567-3572. doi: 10.1200/JCO.2007.15.2868
- Nowak, A.K., Byrne, M.J., Williamson, R., Ryan, G., Segal, A., Fielding, D., & Robinson, B.W.S. (2002). A multicenter phase II study of cisplatin and gemcitabine for malignant mesothelioma. British Journal of Cancer, 87(5): 491-496. doi: 10.1038/sj.bjc.6600505
- Volta, V., Ranzato, E., Martinotti, S., Gallo, S., Russo, M.V., Mutti, L., & Burlando, B. (2013). Preclinical demonstration of synergistic active nutrients/drug (AND) combination as a potential treatment for malignant pleural mesothelioma. PLoS One, 8(3): e58051. doi: 10.1371/journal.pone.0058051
- Kovac, V., et al. (2017). Cisplatin with Pemetrexed or Gemcitabine in Prolonged Infusion for Inoperable Mesothelioma: A Phase II Randomized Trial. Journal of Thoracic Oncology; 12(1):S1362-S1363. doi: 10.1016/j.jtho.2016.11.1929
- Zalcman, G., et al. (2016). Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. The Lancet; 387(10026):1405-1414. doi: 10.1016/S0140-6736(15)01238-6
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