01. What Is Gemcitabine?
What Is Gemcitabine (Gemzar)?
Different chemotherapy drugs kill cancer cells in various ways. Gemcitabine targets DNA, the genetic blueprint for all cellular functions. A dividing cell exposed to gemcitabine incorporates it into its DNA. This can make DNA nonfunctional. It can also help promote the death of cancer cells.
Gemcitabine (Gemzar) Quick Facts
- Generic name: Gemcitabine
- Brand names: Gemzar, Infugem
- Administration: Intravenous
- Often combined with: Gemcitabine has been combined with other chemotherapy drugs, such as cisplatin and/or pemetrexed. These chemotherapies work to interfere with uncontrolled cell growth.
- Types of mesothelioma treated: Biphasic mesothelioma, epithelioid mesothelioma, peritoneal mesothelioma, pleural mesothelioma, sarcomatoid mesothelioma
- Manufacturer: Accord Healthcare Inc., Armas Pharmaceuticals Inc., Athenex Pharmaceutical Division, LLC, Bedford Laboratories, BluePoint Laboratories, Cipla USA Inc., Dr. Reddy’s Laboratories Limited, Edge Pharma LLC, Fresenius Kabi USA, LLC, Gland Pharma Limited, Hikma Pharmaceuticals USA Inc., Hospira, Inc., Meitheal Pharmaceuticals Inc., Mylan Institutional LLC, NorthStar Rx LLC, Sagent Pharmaceuticals, Sun Pharmaceutical Industries, Inc.
- FDA approval: Gemcitabine is approved in combination with other drugs to treat some forms of breast cancer, ovarian cancer and non-small cell lung cancer. Gemcitabine also has approval for treating pancreatic cancer.
02. Gemcitabine and Mesothelioma
How Does Gemcitabine (Gemzar) Treat Mesothelioma?
Patients may receive gemcitabine as part of a treatment plan for malignant mesothelioma. Gemcitabine is not a common mesothelioma drug, but it may be the right treatment for some patients. A mesothelioma doctor can determine if gemcitabine is appropriate for treatment.
Doctors may combine gemcitabine with other chemotherapy drugs. Some chemotherapy drugs work well together because they kill cancer cells in different ways. Gemcitabine works by replacing functional parts of DNA. This can make DNA nonfunctional. It can also encourage natural cancer cell death. Other chemotherapy drugs use different mechanisms to kill fast-dividing cancer cells.
Doctors may also combine gemcitabine with other types of cancer treatment, such as surgery. When used in combination with other drugs and therapies, gemcitabine may lead to better outcomes. Survival of mesothelioma patients treated with gemcitabine in combination with other drugs ranges from about 18 to 39 months.
Gemcitabine mesothelioma treatment is a developing area of study. Researchers continue to explore treatment regimens using this drug. It is currently not approved by the FDA to treat mesothelioma. Its FDA label lists the drug as being approved to treat the following cancers:
Doctors may also use gemcitabine to help treat mesothelioma. Research has indicated that gemcitabine may benefit mesothelioma patients in certain situations. A doctor can determine if gemcitabine is an appropriate treatment.
Gemcitabine (Gemzar) and Other Chemotherapy Drugs for Mesothelioma
A mesothelioma doctor may use gemcitabine as a single agent or in combination with other chemotherapy drugs. There is currently no standard gemcitabine mesothelioma treatment combination. A doctor may combine the following chemotherapy drugs with gemcitabine to treat mesothelioma:
Specialists may also use gemcitabine in combination with innovative methods of administering chemotherapy. For example, it has been used in hyperthermic intrathoracic chemotherapy (HITHOC) procedures. HITHOC is a heated chemotherapy applied within a patient’s chest cavity after surgery. At least one study looked at applying HITHOC with cisplatin and gemcitabine for pleural mesothelioma. Patients treated with HITHOC and surgery had a median overall survival of 20.3 months.
Gemcitabine’s label contains no indication for mesothelioma treatment. However, healthcare providers may use an approved drug to treat conditions not listed on the drug’s label. This is called off-label use. It is both common and legal. Several types of mesothelioma have few, if any, approved treatments. Off-label usage allows doctors to use their judgment to treat mesothelioma and other rare conditions. This can expand treatment options for patients.
Resources for Mesothelioma Patients
03. What to Expect
What to Expect During Treatment
Gemcitabine is one of several possible chemotherapy treatments for mesothelioma. It is not a common chemotherapy option but may benefit certain patients. It may provide an alternative for patients who cannot tolerate other mesothelioma drugs.
Doctors may use gemcitabine as part of a multimodal first-line treatment, such as in combination with surgery. First- and second-line treatments may also use chemotherapy drug combinations that include gemcitabine. First-line therapies are the initial treatments administered to patients. Second-line therapies are treatments administered after initial or first-line therapies have stopped working.
Gemcitabine is administered intravenously. Mesothelioma patients can expect to receive their infusion at a hospital. There is no standard chemotherapy infusion combination for gemcitabine. A specialist can determine which combination is most appropriate for an individual patient.
Intravenous infusions are given in stages divided into different cycles. Dosages are calculated using the surface area of a patient’s skin. Possible ways to administer gemcitabine include:
- Based on a 21-day cycle
- 1250 mg/m2 gemcitabine on days 1 and 8 of each cycle
- Based on a 28-day cycle
- 1250 mg/m2 gemcitabine on days 1 and 8 of each cycle
- 75 mg/m2 cisplatin on day 1 of each cycle
- Based on a 21-day cycle
- 1,250 mg/m2 gemcitabine on days 1 and 8 of each cycle
- 500 mg/m2 pemetrexed on day 8 of each cycle
During infusions, healthcare providers tend to patients to ensure safety. They can track blood cell levels, kidney function and liver function. This monitoring can help address any problems as they arise.
Patients generally rest and recover between treatment cycles. This process continues until treatment is complete.
Preparing for Your Appointment
Patients can prepare for their chemotherapy appointments to help reduce stress. Being prepared and staying organized can help avoid unnecessary complications and discomfort. In preparation for their gemcitabine chemotherapy appointment, mesothelioma patients may want to:
- Arrange post-infusion transportation: Infusions may leave patients feeling tired. Patients are advised to arrange for a ride from the hospital. If a friend or family member cannot provide a ride, transportation services may be available.
- Dress comfortably: Patients may sit for an extended period of time during infusions. They can help avoid discomfort by dressing for warmth and comfort. Healthcare professionals advise patients to dress in layers and non-constrictive clothing.
- Keep medical information organized: During treatment, healthcare providers may ask patients questions about their cancer journey. Organizing medical documents in one place, such as in a binder, can help avoid stress.
- Keep schedule as flexible as possible: Patients should prepare to rest and recover as much as possible after their appointment. They should notify their employers that they may need time off to recover. Patients may also want to ask friends and family members to help with chores and errands.
- Pack a care bag: During infusions, patients may become hungry, thirsty or bored. Packing a bag with items to help avoid these situations may make treatment less uncomfortable. Patients may want to pack snacks, water, crafts and reading materials.
Doctors can help patients know what to expect during a chemotherapy appointment. Mesothelioma patients can also ask their doctor any questions about how to prepare for chemotherapy.
Managing Treatment and Follow-Up Care
Mesothelioma patients may go through several chemotherapy treatment cycles. Mesothelioma doctors can track patient progress. They generally watch for adverse effects and provide follow-up care. They may draw blood to check blood cell levels and organ function.
Patients can also help manage discomfort from treatment in a number of ways. They should pay close attention to any treatment-management instructions from their doctor. In addition to following their doctor’s advice, a patient may want to:
- Avoid activities that may cause injury or bruising
- Avoid areas where they might contract an infection
- Drink plenty of fluids to avoid dehydration
- Eat small meals to stay nourished despite nausea
- Wash hands to reduce infection risk
Patients will have scheduled follow-up appointments with their doctors. It is important for patients to attend these appointments. They are an opportunity for patients to discuss their treatment experience and side effects. A doctor may help patients manage chemotherapy side effects and provide any other necessary follow-up care.
04. Benefits of Gemcitabine
Gemcitabine (Gemzar) Benefits
Gemcitabine may benefit mesothelioma patients in certain instances. For example, it has shown some success in relieving symptoms of pleural mesothelioma. It is also possible it may help delay progression of inoperable mesothelioma in certain situations. Gemcitabine may also provide an alternative for patients who cannot tolerate other mesothelioma drugs. Mesothelioma specialists can determine if gemcitabine may benefit a patient.
Patients who respond well to gemcitabine treatment may experience improvements in certain symptoms. One study looked at the effect of gemcitabine and carboplatin on mesothelioma symptoms. Patients reported improvements in the following mesothelioma symptoms:
- Chest pain
- Difficulty breathing
Another study examined the benefits of using gemcitabine to delay mesothelioma getting worse. Patients in the study already received a first line of treatment. The initial treatment used drugs with different cancer-killing mechanisms than gemcitabine. Treatment with gemcitabine after first-line treatment almost doubled progression-free survival. This study suggests gemcitabine may help improve mesothelioma patients’ quality of life.
There are also potential benefits to combining other types of therapies with gemcitabine. A clinical trial is examining the potential benefits of a combination of gemcitabine and immunotherapy for progressive mesothelioma. Researchers are continuing to look for new ways to treat mesothelioma.
05. Side Effects of Gemcitabine
Gemcitabine (Gemzar) Side Effects
Patients receiving gemcitabine to treat mesothelioma may experience side effects. Common side effects include nausea, difficulty breathing and anemia. Side effects may vary based on different factors. For example, different drug and therapy combinations may cause various side effects.
A mesothelioma doctor can explain potential side effects to a patient. They can also help manage any side effects or adverse events that occur as a result of treatment.
Potential Side Effects of Gemcitabine (Gemzar)
- Difficulty breathing
- Hair loss
- Inflammation of the mouth and lips
- Nausea and vomiting
- Tingling/prickling sensation
- Bone marrow suppression
- Capillary leak syndrome
- Kidney inflammation
- Liver toxicity
- Lung scarring
- Swelling/collection of fluid in lungs
Managing Side Effects
Patients experiencing side effects from gemcitabine should speak to their doctor. A doctor can provide help and recommendations to manage treatment side effects. Managing side effects can help improve patients’ quality of life during treatment.
Patients may take steps before and during infusion to help with treatment side effects. For example, doctors may administer side effect-easing supplements to patients. The types of supplements may depend on which drugs gemcitabine is combined with. Possible supplements may include:
- Folic acid: This may be administered daily before and during treatment. It can help reduce the toxic effects of chemotherapy on a patient’s blood.
- Steroids: This may be administered before the beginning of each treatment cycle. It can help reduce the risk of severe skin rash.
- Vitamin B12: This may be administered before and periodically during treatment. It can help reduce the toxic effects of chemotherapy on a patient’s blood.
Certain side effects can be addressed as they occur. For example, nausea is a common side effect of gemcitabine treatment. Patients may want to adjust their nutrition during and after chemotherapy to help with nausea. Eating several smaller meals throughout the day may help.
Doctors may also prescribe anti-nausea medication. Healthcare providers recommend patients take the prescribed dose for the best outcomes. A dietitian may also be able to help develop a nutrition plan for patients. This can help patients maintain nutrition during treatment.
Patients should also consult with their doctor before using any new drug or supplement. It is possible certain drugs or supplements may interfere with treatment. A doctor can determine if a drug or supplement is safe to take with gemcitabine.
06. Gemcitabine Eligibility
Who Is Eligible for Gemcitabine (Gemzar)?
Specialists may determine eligibility for gemcitabine treatment based on different criteria. There is currently no standard treatment for gemcitabine mesothelioma treatment. Patients should talk with their doctors about eligibility when making treatment decisions.
Doctors may use gemcitabine to help treat malignant pleural mesothelioma. Patients with a performance status of two may be eligible for gemcitabine. Performance status is a measure of a person’s ability to engage in daily activity.
Gemcitabine may not be appropriate for patients who:
- Are currently undergoing radiation therapy
- Have a known hypersensitivity to gemcitabine
If a patient is ineligible for gemcitabine treatment, a doctor can help them explore other treatment options.
07. Gemcitabine Studies
Clinical Trials and Studies on Gemcitabine (Gemzar) for Mesothelioma
Mesothelioma researchers continue to explore gemcitabine’s treatment potential through studies and clinical trials. Some studies have yielded promising results. Currently, gemcitabine is not commonly used to treat mesothelioma. But researchers are always looking for new methods to treat this rare disease and improve survival.
Gemcitabine’s effectiveness has been studied in combination with other drugs and therapies. One study of gemcitabine looked at the effectiveness of a combination of procedures:
- First procedure: Surgery, either an extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D)
- Second procedure: HITHOC, a heated chemotherapy, applied to the chest cavity using a combination of cisplatin and gemcitabine
The study found encouraging results for pleural mesothelioma patients who underwent P/D plus HITHOC. This combination resulted in a median survival of 38.8 months. This is almost double the median survival for stage 1 pleural mesothelioma reported in a prior study.
At least one clinical study is looking at combining gemcitabine with immunotherapy. The study seeks to determine the efficacy of gemcitabine combined with atezolizumab for progressive pleural mesothelioma. Researchers will study this combination treatment on patients who have relapsed or did not respond to standard therapies. The study has an estimated completion date of 2025.
Gemcitabine (Gemzar) in Switch-Maintenance Therapies
Researchers have also studied gemcitabine’s use in switch-maintenance therapy. Switch-maintenance therapy is a treatment intended to stop or delay cancer recurrence. It is administered to patients who have responded to initial treatment. It uses a therapy with a different cancer cell-killing mechanism than the one used during initial treatment.
A study of 130 pleural mesothelioma patients looked at gemcitabine switch-maintenance therapy. All patients first received a standard first line of chemotherapy treatment. At the time patients received switch-maintenance therapy, they had no evidence of mesothelioma progression.
Gemcitabine switch-maintenance treatment almost doubled the median progression-free survival for patients. Progression-free survival may positively impact mesothelioma patients’ quality of life. According to one expert, this is because progression has a major effect on severity and number of symptoms.
Research has shown gemcitabine may be an appropriate mesothelioma treatment in certain situations. Researchers also continue to explore gemcitabine’s potential applications. Patients can speak to their doctors about whether gemcitabine might benefit them.