Gemcitabine - chemotherapy medicine sometimes used for mesothelioma

Gemcitabine, marketed as Gemzar, is a drug used during chemotherapy treatment of certain types of cancers, including mesothelioma, metastatic breast cancer, non-small cell lung cancer, pancreatic cancer, and ovarian cancer. Depending on the case, Gemcitabine treatments can either be given alone or combined with a few other cancer medicines.

Brief History

Gemcitabine was first studied in clinical trials in the United States during the early 1990s. A year prior to its approval by the FDA in 1996, Gemcitabine was made available to doctors for the treatment of pancreatic cancer patients in a Treatment Investigational New Drug (TIND) study. Over 3000 patients with pancreatic cancer were able to receive Gemcitabine during the TIND study.

In these trials, patients receiving the Gemcitabine regimen experienced an increase in their one-year survival time that was significantly better than that seen with the comparator regimen.

In 1998, Gemcitabine received an additional approved indication, based on two clinical trials conducted in patients with non small cell lung cancer. Patients were treated either with Gemcitabine in combination with cisplatin, a standard platinum agent, or with a platinum regimen. In both studies, patients who received the Gemcitabine regimen experienced significant tumor shrinkage—at least two times that experienced by patients receiving either of the comparator regimens.

In 2004, Gemcitabine received an additional approved indication, based on a large clinical trial of 529 patients. Given with another chemotherapy drug called paclitaxel, Gemcitabine is indicated for the first-line treatment of patients with metastatic breast cancer when, after surgery, they have had chemotherapy with a class of drugs called anthracyclines, unless their physical condition would not allow them to receive an anthracycline.

In the clinical study, patients with metastatic breast cancer were given either Gemcitabine in combination with paclitaxel or paclitaxel alone. The clinical study showed that patients treated with the Gemcitabine combined with paclitaxel experienced more tumor shrinkage compared with patients who received paclitaxel alone.

How Gemcitabine is Administered

Gemcitabine is a colorless fluid which is obtained after dissolving the white powder. It is given as a drip through a fine tube inserted into a vein, over a short period of time.

How it Works

Gemcitabine works by controlling the growth of rapidly dividing cells which includes the cancer cells—these cancer cells are abnormal cells which grow at uncontrolled rate. The main goal of Gemcitabine is to kill as many cancer cells as possible or to halt the process of cell division in order to prevent further cell growth cause cell death.

This is done by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells do not divide, they die. Chemotherapy more likely kills the cells if the cells are diving faster which causes the tumor to shrink. It also induces cell suicide or apoptosis.

Unfortunately, chemotherapy is unable to differentiate between the cancerous cells and the normal cells. Chemotherapy kills all the cells that are dividing faster. The "normal" cells grow back but in the meantime, side effects occur. The "normal" cells which commonly get affected by chemotherapy are blood cells, the cells in the stomach, bowel, mouth, and the hair follicles.

Side Effect of Gemcitabine

At the end of treatment fatigue and tiredness can be the most troublesome side effects that the patients may encounter. For some people it takes almost 6 months to a year after their treatment to get their energy back to normal.

The functioning of bone marrow that makes white blood cells is also temporarily affected. Now, as lesser white blood count means lesser ability to fight infections, drop in the functioning of bone marrow can increase the chances of infections in patients. This can result in headaches, cough, aching muscles, sore throat, and pain while passing urine. You may also feel cold and shivery. Sometimes infections can be life threatening and it is recommended that you immediately contact your doctor in case it occurs.

Problems in functioning of bone marrow may also cause a drop in the number of red blood cells made by bone marrow. This can result in anemia, which may in turn, cause breathlessness and tiredness. In this case, the patient may be required to undergo blood transfusion.

A drop in the number of platelets produced by bone marrow may cause nosebleeds. Patients may also see tiny red spots or bruises on arms or legs.

Availability And Storage Of Gemcitabine

Gemcitabine is available in two strengths, 200 milligrams and 1 gram which is single use vial.

  • 200 milligrams: Each vial contains Gemcitabine HCl equivalent to Gemcitabine 200 mg as free base.
  • 1 gram: Each vial contains Gemcitabine HCl equivalent to Gemcitabine 1 g as free base.

The annual sale of these strengths of Gemcitabine injections is approximately $680 million in the United States.

Gemcitabine should be stored away from moisture, heat and light. It should be stored at the room temperature between 59 and 86 degrees F.

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