Gemcitabine for Mesothelioma

Gemcitabine, sold under the brand name Gemzar, is an anticancer chemotherapy drug used to treat mesothelioma and other cancer types, including ovarian and non-small cell lung cancer. Doctors typically use gemcitabine in combination with other cancer drugs to fight mesothelioma.

Written and Fact-Checked by: Laura Wright

What Is Gemcitabine?

For many mesothelioma patients, the most effective chemotherapy combination is the platinum-based chemo drug cisplatin and pemetrexed (Alimta).

In most cases, gemcitabine chemotherapy is only used when a patient can’t tolerate cisplatin, has an allergy, or there’s some other reason the cisplatin and pemetrexed combination shouldn’t be used. Gemcitabine is not as harsh as cisplatin and some other chemotherapy drugs.   

Gemcitabine is often combined with other chemo drugs. Studies have shown that gemcitabine in combination with other chemotherapy medications has a significantly better outcome than gemcitabine on its own.

The U.S. Food and Drug Administration approved gemcitabine in 1996 under the brand name Gemzar for treating lung cancer and mesothelioma.

In addition to mesothelioma, gemcitabine is used to treat many other types of cancer, including metastatic breast cancer, ovarian cancer, pancreatic cancer, and bladder cancer.

How Is Gemcitabine Administered for Mesothelioma?

Health care professionals administer gemcitabine injections through an intravenous (IV) infusion. This method delivers the chemo medication directly into the patient’s bloodstream.

Gemcitabine’s treatment cycle is typically 21 days, with patients receiving the medication once every three weeks. Mesothelioma patients often receive gemcitabine for several cycles in a row, especially when showing positive changes.

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How Does Gemcitabine Treat Mesothelioma?

Gemcitabine is a type of chemotherapy drug known as an antimetabolite. Antimetabolites block DNA synthesis and slow or stop mesothelioma cancer cells from dividing.

Like all chemotherapy drugs, gemcitabine can’t tell the difference between cancer cells and healthy cells. As a result, it attacks cancer cells and healthy cells. During treatment, white blood cells, red blood cells, and platelets are often destroyed.

The good news is that healthy cells usually replenish themselves after a few weeks.

Gemcitabine Drug Combinations

Gemcitabine is most effective when combined with other chemotherapy drugs. Oncologists often prescribe it because of its lower toxicity and milder side effects than other chemo medications.

A male doctor speaks with an older male patient

For example, gemcitabine is often chosen as a second line of chemotherapy for patients who can’t tolerate harsher platinum-based drugs like cisplatin and carboplatin. For these mesothelioma patients, gemcitabine and pemetrexed is a common combination for mesothelioma treatment.

Gemcitabine chemotherapy is sometimes combined with cisplatin or carboplatin, although this combination isn’t as common.

Gemcitabine and cisplatin can produce high toxicity levels and cause severe side effects. Gemcitabine and carboplatin toxicity levels are still higher than gemcitabine and pemetrexed. As a result, gemcitabine and platinum-based chemotherapy are typically reserved for patients who can tolerate high toxicity but aren’t good candidates for pemetrexed.

Cancer researchers continue researching gemcitabine combinations in laboratory and clinical trials for mesothelioma. Some of these tests focus on improved chemotherapy combinations, while others are reviewing gemcitabine in combination with smart drugs.

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Current Gemcitabine Clinical Trials

Early studies of gemcitabine revealed that the drug has minimal impact on mesothelioma when given as the only chemotherapy treatment.

However, gemcitabine is still appreciated by patients and oncologists because of its relatively low toxicity levels. Today, clinical trials for mesothelioma evaluate gemcitabine’s effectiveness when combined with other chemotherapy drugs or mesothelioma treatments.

Doctor speaking to a mesothelioma patient.

Gemcitabine and vinorelbine, a plant-based chemo drug, are being directly compared to a new experimental immunotherapy drug called pembrolizumab (Keytruda®).

Pembrolizumab, approved for certain mesothelioma patients in 2020, is potent and blocks the interaction between molecules that cause cancer tumors to grow. The hope is that pembrolizumab will stop growth, force tumors into regression, and ultimately cause the body to reject the cancer.

In another clinical study, researchers are testing transarterial chemoperfusion (killing the blood supply to mesothelioma cells) with gemcitabine, cisplatin, and methotrexate. Additionally, scientists are investigating the use of gemcitabine in combination with gene therapy to treat patients with pleural mesothelioma.

Italian researchers are studying gemcitabine with or without ramucirumab as a second-line treatment for patients with advanced malignant pleural mesothelioma. Ramucirumab is a monoclonal antibody that prevents the growth of new blood vessels and limits a tumor’s oxygen supply.

Phase 2 study results of 161 patients revealed that patients who received both drugs had much better outcomes — overall median survival of 13.8 months compared to 7.5 months — than patients who only received gemcitabine.

HIPEC Database

Mesothelioma specialists worldwide are also creating a database of patients who have received gemcitabine or other chemotherapy medications during Hyperthermic Intraperitoneal Chemotherapy (HIPEC). HIPEC, or heated chemotherapy, is often used to treat patients with peritoneal mesothelioma as part of a two-part procedure known as cytoreduction surgery with HIPEC.

The international initiative gathers data and outcomes from 1,000 mesothelioma patients to help determine whether gemcitabine should be used in the HIPEC procedure. Thirteen countries participate in the collaborative project, including Australia, Denmark, Germany, and Russia.

Gemcitabine Side Effects

Patients receiving gemcitabine can expect to experience common side effects, including flu-like symptoms such as chills, fever, and tiredness.

Other gemcitabine side effects include:

  • Anemia
  • Constipation
  • Hair loss
  • Loss of appetite
  • Low blood cells
  • Nausea
  • Skin rash
  • Vomiting

Although gemcitabine side effects are rarely life-threatening, some patients may have an allergic reaction. Patients should report any adverse effects to their oncology team.

Most gemcitabine patients will have low blood counts and are at a greater risk of anemia and infection at this time. Blood levels typically reach their lowest point 10-14 days after gemcitabine is administered. Blood levels usually return to normal 21 days after treatment.

Fortunately, all gemcitabine side effects follow predictable patterns and don’t tend to last long after chemotherapy has stopped. Mesothelioma patients can expect the negative side effects of gemcitabine to subside after their treatment ends.

If you’ve been diagnosed with mesothelioma, you may be a candidate for chemotherapy treatment.

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Gemcitabine FAQS

What kind of chemo is gemcitabine?

Gemcitabine, known by the brand name Gemzar, is in a type of chemotherapy drug that is considered an antimetabolite.

Antimetabolites work by interfering with DNA synthesis and slowing or halting the growth of cancer cells.

Gemcitabine is used to treat many types of cancer, including mesothelioma, breast cancer, ovarian cancer, and bladder cancer.

It is usually used in combination with other chemo drugs.

What is the success rate of gemcitabine?

Researchers are currently studying the success rate of gemcitabine either alone or with other chemotherapy drugs or therapies in patients with mesothelioma.

In a recent clinical study of 161 patients, Italian researchers looked at the use of gemcitabine with or without a monoclonal antibody called ramucirumab as second-line treatment for advanced malignant pleural mesothelioma. Ramucirumab blocks the growth of new blood vessels, which limits the supply of oxygen to the tumor.

The researchers found that the patients who received both drugs had much better outcomes — overall median survival of 13.8 months compared to 7.5 months — than the patients who only received gemcitabine.

Written by:

Lead Editor

Laura Wright is a journalist and content strategist with more than 14 years of professional experience. She attended college at the University of Florida, graduating magna cum laude with a bachelor’s degree in journalism in 2008. Her writing has been featured in The Gainesville Sun and other regional publications throughout Florida.

7 References
  1. American Association for Cancer Research. “Evaluation of the Antitumor Activity of Gemcitabine (2′,2 ‘ -Difluoro-2 ‘ -deoxycytidine).” Retrieved from http://cancerres.aacrjournals.org/content/canres/50/14/4417.full.pdf. Accessed on December 15, 2022.

  2. Chemocare. “Gemcitabine.” Retrieved from http://chemocare.com/chemotherapy/drug-info/gemcitabine.aspx. Accessed on December 15, 2022.

  3. Mesothelioma Applied Research Foundation. “Updates in mesothelioma research from ASCO 2020.” Retrieved from: https://www.curemeso.org/2020/06/16/updates-in-mesothelioma-research-from-asco-2020/. Accessed on December 15, 2022.

  4. National Cancer Institute. “FDA Approval for Gemcitabine Hydrochloride.” Retrieved from https://www.cancer.gov/about-cancer/treatment/drugs/gemcitabinehydrochloride. Accessed on December 15, 2022.

  5. U.S. National Library of Medicine. “PembROlizuMab Immunotherapy Versus Standard Chemotherapy for Advanced prE-treated Malignant Pleural Mesothelioma (PROMISE-meso).” Retrieved from https://clinicaltrials.gov/ct2/show/NCT02991482. Accessed on December 15, 2022.

  6. U.S. National Library of Medicine. “Transarterial Chemoperfusion: Cisplatin, Methotrexate, Gemcitabine for Unresectable Pleural Mesothelioma.” Retrieved from https://clinicaltrials.gov/ct2/show/NCT02611037. Accessed on December 15, 2022.

  7. U.S. National Library of Medicine. “International Registry of Patients Treated With Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) (PIPACRegis).” Retrieved from https://clinicaltrials.gov/ct2/show/NCT03210298. Accessed on December 15, 2022.

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