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Gemcitabine
Table Of Contents
The chemotherapeutic drug gemcitabine is most often used to treat pancreatic, ovarian and breast cancers. Doctors also found success in the treatment of pleural and peritoneal mesothelioma and certain types of lung cancer, and often use the drug in combination with another chemotherapy drug to treat these forms of cancer.
Written by Karen Selby, RN | Medically Reviewed By Dr. Jeffrey Velotta | Edited By Walter Pacheco | Last Update: August 26, 2024
Written by Karen Selby, RN | Medically Reviewed By Dr. Jeffrey Velotta | Edited By Walter Pacheco | Last Update: August 26, 2024
What Is Gemcitabine?
Most chemotherapeutic drugs work by killing cells with complex chemical reactions. Gemcitabine can slow the growth of pleural mesothelioma by interfering with the DNA replication of cancer cells.
Gemcitabine was discovered and developed by scientists at the pharmaceutical company Eli Lilly. Gemzar is the registered name of gemcitabine for injection. Mesothelioma patients who do not tolerate platinum-based chemotherapy drugs such as cisplatin or carboplatin may do well on gemcitabine.
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 |
Recent research on gemcitabine for mesothelioma combines the drug with immunotherapy, targeted therapy and gene therapy agents. Pairing gemcitabine with other anti-cancer drugs improves outcomes for people with mesothelioma.
Before beginning gemcitabine treatment, patients must inform their doctor of any current medications being taken, including all prescription drugs and any vitamins, supplements or over-the-counter medications.
Anyone who has impaired liver or kidney function is generally not advised to use gemcitabine, because the drug can cause severe liver and kidney damage. Because gemcitabine and most chemotherapy drugs are known to harm unborn babies, pregnant women should not use these drugs.
The goal of chemotherapy is to actually slow down or kill the rapidly growing cancer cells that are growing 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.
Gemcitabine in Treatment for Mesothelioma
Gemcitabine chemotherapy is most often performed on an outpatient basis and is administered intravenously. Treatment typically involves a trip to a doctor’s office, clinic or hospital. The procedure usually takes a few hours, with the actual administration of the drug lasting around 30 minutes. In most cases, it is administered on various schedules, the most common being once a week for three weeks, followed by one week off. The length of treatment and strength of dosage that is best for your cancer doctor will determine you.
Gemcitabine, or Gemzar, is another chemotherapy drug for mesothelioma that can be given alone or in combination 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 administered alone or in combination with another chemotherapy agent or other anti-cancer drugs. It may be used in first-line or second-line chemotherapy regimens for mesothelioma.
First-line chemotherapy with gemcitabine is often given in combination with another chemotherapy drug, such as cisplatin. Second-line chemotherapy with this drug may be administered alone or in combination, depending on the patient’s response to first-line chemotherapy. Gemcitabine is used more often in second-line chemotherapy for mesothelioma than first-line because cisplatin and pemetrexed produce longer survival rates.
Side Effects of Gemcitabine
The most common side effects of treatment with gemcitabine include nausea, flu-like symptoms and increased risk of infection.
Gemcitabine Side Effects
- Nausea and vomiting
- Tendency to bruise or bleed easily
- Constipation or diarrhea
- Swelling in the ankles, feet or hands (edema)
- Less frequent urination
- Blood in urine, or particularly dark urine
- Change in kidney function
- Change in liver function
- Chest pain
- Numbness or weakness, most often on one side of the body
- Confusion, balance impairment or impaired vision or speech
- Fever, chills and body aches (similar to symptoms of flu)
- Sores or white patches inside the mouth
- Pain or swelling at the location where gemcitabine was administered
People treated with chemotherapy drugs have reduced immune system function because these drugs kill specific immune cells. If you take gemcitabine for mesothelioma cancer, avoid contact with people with colds or other infections. A medical face mask may be worn to protect you from contact with germs.
Gemcitabine Studies
Several phase II clinical trials have investigated gemcitabine’s effectiveness on mesothelioma. Some phase II trials report higher response rates or overall survival rates than others. Despite inconsistent results, the consensus is that the drug benefits people with mesothelioma.
In 2024, an ongoing clinical trial is evaluating the effects of combining gemcitabine with ramucirumab for mesothelioma after progression on therapy with platinum and pemetrexed chemotherapy. Early results show ramucirumab plus gemcitabine significantly improved overall survival over gemcitabine and placebo and had a favorable safety profile.
Gemcitabine was tested in a prolonged (over 6 hours) low-dose infusion regimen in combination with cisplatin in a 2017 study. This low-dose approach increased the effectiveness of gemcitabine against mesothelioma, although it did cause more hair loss than the average dose in 30 minutes of infusion. Overall survival was 16.16 months, which is among the longest survival times reported for mesothelioma chemotherapy.
The results [of the 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.
In 2012, results were published from a phase II clinical trial led by mesothelioma expert Dr. Hedy Kindler on the combination of gemcitabine, cisplatin and bevacizumab (a drug that cuts blood supply to tumors). Anti-angiogenesis drugs such as bevacizumab block the formation of new blood vessels, which is the pathway through which tumors spread cancerous cells in the body. Adding bevacizumab improved progression-free survival and overall survival in some participants, but the effect was not significant enough among all participants to warrant further study.
In 2002, an Australian phase II clinical trial evaluated the combination of gemcitabine and cisplatin as first-line chemotherapy for pleural mesothelioma. Researchers reported a partial response (meaning the tumor shrank by more than 30%) in 33% of participants. Participants reported improved quality of life following recovery from treatment and improved respiratory function. The overall survival from the start of treatment was 11.2 months.
Studies continue to investigate the best ways to administer gemcitabine for the treatment of mesothelioma. The drug’s effectiveness may be improved with the addition of other chemotherapy drugs, targeted therapies and nutrition. Trials are ongoing to improve the outcomes of people treated with the drug. People facing mesothelioma who undergo treatment with this drug may experience reduced symptoms, improved quality of life and extended survival.
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