Gemzar is a brand name chemotherapy drug made by Eli Lilly. The generic name of this drug is gemcitabine. While Gemzar has been used for more than 20 years, it is still considered a newer chemotherapeutic agent. This drug has the potential to be an effective treatment for many cancers it has not yet been approved for, including mesothelioma.
Gemzar is currently approved to treat certain cases of ovarian, pancreatic, and non-small cell lung cancer. Research into gemcitabine for mesothelioma is ongoing. Typically used in combination with other drugs, including chemotherapy drugs and newer targeted drugs, the risks of using Gemzar must be weighed against the potential benefits.
What is Gemcitabine?
Gemcitabine is the generic name of the Eli Lilly drug called Gemzar. It was approved for use in 1996, and is now is now available as a generic drug from companies like Teva Pharmaceuticals, Hospira, and Fresenius. Approved uses for gemcitabine include treatment for relapsed and advanced ovarian cancer (in combination with carboplatin), non-small cell lung cancer (in combination with cisplatin), and pancreatic cancer. It is also approved to treat metastatic breast cancer in combination with paclitaxel.
Gemcitabine is sometimes used to treat bile duct cancer and bladder cancer, although it has not been approved for this use. It has not been approved for mesothelioma, though many studies have used it in combination with other drugs to treat this difficult cancer. Results are mixed but largely positive. This should lead to further clinical trials and eventually new combination therapies to help more mesothelioma patients.
How it Works
Like most chemotherapy drugs, gemcitabine is administered through injection. Traveling through the bloodstream, it targets fast-growing cells specifically. While gemcitabine effectively destroys cancer cells, it also affects some of helathy cells in the body.
Gemcitabine belongs to a class of drugs called antimetabolites. Antimetabolites interfere with the enzymes that make DNA in cells. They do this by mimicking compounds the enzymes would normally bind to, halting the action of those enzymes. Since DNA is required for cell division, once the cancer cells are unable to make DNA, they stop spreading.
Because gemcitabine does not specifically target cancer cells, it can cause uncomfortable, painful, and sometimes serious side effects. The most common side effects are nausea, vomiting, anemia, hair loss, mouth sores, loss of appetite, reduced white blood cell count, and excessive protein in the urine. This drug can also cause fever, skin rashes, labored breathing, swelling in the extremities, low blood platelets, and an increase in liver enzymes.
Some patients are not good candidates for gemcitabine because of its toxic effects. This includes pregnant women, because this drug can lead to serious birth defects. Patients with weakened immune systems may also need to avoid gemcitabine. Suppression of white blood cell production in bone marrow can be very serious, making patients susceptible to life-threatening infections. Patients with liver disease may also be more susceptible to liver damage from gemcitabine.
Gemcitabine and Mesothelioma – Studies
While gemcitabine has not yet been approved by the FDA for mesothelioma, researchers are attempting to determine if it works against this difficult cancer. Several tests, including those that have advanced to phase II clinical trials, show great potential for gemcitabine in combination with other drugs. While work remains to win regulatory approval for mesothelioma, early results are promising.
A 2002 phase II trial in Australia tested gemcitabine along with cisplatin in pleural mesothelioma patients. One-third of patients saw some reduction in tumor size, while nearly two-thirds experienced stabilization in tumor growth. Only 8 percent of patients saw no benefit. Most patients in the trial reported a better quality of life after treatment, meaning gemcitabine reduced symptoms of the cancer.
Another phase II clinical trial, published in 2012, used a combination of gemcitabine, cisplatin, and bevacizumab. Bevacizumab is an anti-angiogenesis drug which acts against tumors by reducing their ability to grow new blood vessels. A tumor cannot continue to grow without a blood supply. The combination of these three drugs improved overall survival times for patients in the study. It also improved progression-free survival times, the time between treatment and the point at which a tumor begins to regrow.
In 2013, researchers published interesting results from an animal study using gemcitabine. Animal trials typically precede human clinical trials. Researchers treated mice with peritoneal mesothelioma with a combination of drugs that included gemcitabine. The researchers used a lower dose of gemcitabine than would normally be used and added a compound from green tea called EGCG and vitamin C supplements. The results were as effective as higher doses of gemcitabine alone. Therefore, it may be possible to use lower doses, reducing side effects, while still slowing tumor growth.
These and ongoing clinical trials show great promise for gemcitabine as a mesothelioma treatment. More studies are necessary, however. Researchers will likely continue combining gemcitabine with other chemotherapy drugs. They may also combine the drug with with new, more targeted compounds like immunotherapy drugs and vaccine therapies. Testing chemotherapy drugs for unapproved uses often leads to new treatments and greater hope for patients struggling with diseases like mesothelioma.
Page Edited by Dave Foster
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