Written By: Devin Golden
Gemcitabine for Mesothelioma
Gemcitabine is an experimental chemotherapy drug for malignant mesothelioma. It’s used as a second- or third-line therapy in conjunction with FDA-approved chemotherapy drugs cisplatin and pemetrexed to potentially prolong survival.
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
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Important Facts About Gemcitabine
- Gemcitabine is not FDA-approved for malignant mesothelioma. Doctors may give patients this drug with either cisplatin or pemetrexed.
- One study tested low doses of gemcitabine continuously with cisplatin and the results were impressive.
- Side effects of gemcitabine include nausea, vomiting, weakness and muscle pains.
What Is Gemcitabine?
Gemcitabine, the generic name for Gemzar, is an antimetabolite chemotherapy drug approved by the U.S. Food and Drug Administration for general cancer treatment in 1996. Antimetabolites stop cells from manufacturing DNA and RNA, which are essential for cell growth.
Mesothelioma is the result of genetic mutations to healthy cells due to asbestos fibers. This mutation causes an abnormal cell division, or cellular growth. Healthy cells submit to apoptosis, which is effectively described as cellular suicide, but mesothelioma cells grow out of control and form tumors instead of dying off.
Gemcitabine disrupts the growth and spread of mesothelioma by attacking the genetic material within mesothelioma cells.
Gemcitabine is paired with other mesothelioma chemotherapy medications for the best results. It is not found to be beneficial for patients on its own. The pairings include:
- Vinorelbine (generic name for Navelbine)
- Pemetrexed (generic name for Alimta)
- Cisplatin
- Carboplatin
Survival From Gemcitabine for Mesothelioma
Gemcitabine has varying survival and life expectancy results across studies. Some believe gemcitabine can improve a patient’s prognosis compared to the standard of cisplatin and pemetrexed for mesothelioma.
A research team at the Thoracic Oncology Unit of Instituto Nacional de Cancerología in Mexico City, Mexico, tested a new approach to gemcitabine for mesothelioma. Patients received cisplatin plus low doses of gemcitabine continuously via infusion.
The average survival time was approximately 16-17 months. This length is an improvement from cisplatin and pemetrexed, which usually has survival of 12-14 months.
Around 40% of patients lived for at least 20 months, and 35% reached 30 months. It’s the only known study to report better survival times for gemcitabine than the FDA-approved combination.
The study included 80 people with malignant mesothelioma. They received 250 mg of gemcitabine infused continuously over six hours. This occurred once every 21-day cycle for up to 11 cycles (the average number of cycles was six).
Another study tested gemcitabine on its own. The results, published in the journal Lung Cancer, reported a median survival of 4.9 months, which is far below cisplatin and pemetrexed together. Gemcitabine held the mesothelioma stagnant for 1.6 months until it began spreading again.
Cost of Gemcitabine
Researchers in the Mexico study of gemcitabine survival also analyzed cost. They indicated low-dose gemcitabine with cisplatin was the least-expensive option for patients. They compared it to:
- Pemetrexed and cisplatin
- Pemetrexed, cisplatin and bevacizumab
- Short-infusion gemcitabine plus cisplatin
Low-dose gemcitabine was less than half as expensive as pemetrexed with cisplatin. It was 10 times less expensive than adding bevacizumab. It was a little more than half as expensive as the short-infusion option.
Dosing of Gemcitabine
Dosage of gemcitabine, the number of cycles, number of doses in a cycle and how long a session lasts depends on the specific study and the patient’s health. According to the book Hematology-Oncology Therapy:
- Usual length of time is 30-60 minutes
- Average number of cycles is six
- Dosage of gemcitabine is often 1,250 mg
These are often adjusted in studies. For example, in the study cited in Lung Cancer, patients received 1,000 mg on days 1 and 8 of 21-day cycles. In the Mexico City study, the doctors tested a lower dosage of 250 mg continuously over six hours.
The type of chemotherapy also affects the dosage, number of cycles and length of session. A study testing dwell chemotherapy used gemcitabine and cisplatin. There were four cycles of the treatment. Dwell chemotherapy leaves the treatment in the patient’s body for multiple days.
The dwell chemotherapy study, which involved cytoreduction with HIPEC, had a median survival of 54 months.
Gemcitabine Side Effects
Gemcitabine can cause common chemotherapy side effects. According to the Mayo Clinic website, gemcitabine can cause nausea and vomiting, along with:
- Chills
- Fever
- Headaches
- Muscle pains
- Weakness
How to Start Gemcitabine for Mesothelioma
If you’re interested in taking the chemotherapy medication gemcitabine for mesothelioma, follow these three steps:
- Look up information about gemcitabine. Compare the survival rates, side effects and more with other mesothelioma chemotherapy drugs.
- Find a mesothelioma cancer center with an oncologist who will prescribe gemcitabine. Since this drug is still experimental and not FDA-approved, you’ll need to discuss this treatment option with your oncologist.
- Contact our patient advocates for guidance. They’ll empower you to discuss using gemcitabine as a potential treatment option with your care team.
Sources & Author
- Efficacy, Safety, and Cost-Minimization Analysis of Continuous Infusion of Low-Dose Gemcitabine Plus Cisplatin in Patients With Unresectable Malignant Pleural Mesothelioma. Frontiers in Oncology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8095245/. Accessed: 05/24/2021.
- Vinorelbine and Gemcitabine as Second- or Third-Line Therapy for Malignant Pleural Mesothelioma. Lung Cancer. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4343315/. Accessed: 06/15/2021.
- Mesothelioma Regimen: Bevacizumab + Gemcitabine + Cisplatin. Hematology-Oncology Therapy. Retrieved from: https://hemonc.mhmedical.com/content.aspx?sectionid=263408350&bookid=3131#263408427. Accessed: 06/15/2021.
- Gemcitabine (Intravenous Route). Mayo Clinic. Retrieved from: https://www.mayoclinic.org/drugs-supplements/gemcitabine-intravenous-route/side-effects/drg-20066935?p=1. Accessed: 06/15/2021.
- Pemetrexed and gemcitabine versus carboplatin and gemcitabine in non-small cell lung cancer: a randomized noninferiority phase II study in one center. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/25732264. Accessed: 05/16/19.
