Gemcitabine (Gemzar)

General information

Class/mechanism: Pyrimidine analog; metabolized within cells to the active nucleoside forms: diphosphate (dFdCDP) and triphosphate (dFdCTP). Gemcitabine diphosphate inhibits ribonucleotide reductase, which catalyzes reactions that produce deoxynucleoside triphosphates for DNA synthesis. This inhibition of deoxynucleoside triphosphates helps gemcitabine triphosphate to compete with deoxycytidine triphosphate (dCTP) to be incorporated into DNA. DNA synthesis is halted, since only one additional nucleotide can be added to a DNA strand after gemcitabine is incorporated.
Route: IV
Extravasation: irritant or neutral, depending on reference

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.

Diseases for which it is established (work in progress)

• Ovarian cancer
• Peripheral T-cell lymphoma

Diseases for which it is used

• Carcinoma of unknown primary
• Anaplastic large cell lymphoma
• Bladder cancer
• Breast cancer
• Cervical cancer
• Cholangiocarcinoma
• Diffuse large B-cell lymphoma
• Esophageal cancer
• Ewing sarcoma
• Extranodal NK- and T-cell lymphoma, nasal type
• Gallbladder cancer
• Hepatocellular carcinoma
• Hodgkin lymphoma
• Leiomyosarcoma
• Malignant pleural mesothelioma
• Nasopharyngeal carcinoma
• NK- and T-cell lymphoma
• Non-small cell lung cancer
  • Non-small cell lung cancer, nonsquamous
  • Non-small cell lung cancer, squamous
• Osteosarcoma
• Pancreatic cancer
• Primary mediastinal B-cell lymphoma
• Renal cell carcinoma
  • Sarcomatoid renal cell carcinoma
• Small cell lung cancer
• Soft tissue sarcoma
• Testicular cancer
• Thymoma
• Transformed lymphoma
• Upper tract urothelial carcinoma

Patient drug information

• Gemcitabine (Gemzar) package insert
• Gemcitabine (Gemzar) patient drug information (Chemocare)
• Gemcitabine (Gemzar) patient drug information (UpToDate)

History of changes in FDA indication

Breast cancer

• 5/19/2004: New FDA indication in combination with paclitaxel is indicated for the first-line treatment of patients with metastatic breast cancer after failure of prior anthracycline-containing adjuvant chemotherapy, unless anthracyclines were clinically contraindicated.

Non-small cell lung cancer

• 8/25/1998: Indicated in combination with cisplatin for the first-line treatment of patients with inoperable, locally advanced (Stage IIIA or IIIB) or metastatic (Stage IV) non-small cell lung cancer.

Ovarian cancer

• 7/14/2006: FDA approved in combination with carboplatin for the treatment of patients with advanced ovarian cancer that has relapsed at least 6 months after completion of platinum based therapy. (Based on AGO-OVAR 2.5)
• 3/19/2010: New FDA indication for ovarian cancer in combination with carboplatin. (Prior exposure requirement removed)
• 5/7/2013: FDA indication revised: in combination with carboplatin, for the treatment of advanced ovarian cancer that has relapsed at least 6 months after completion of platinum-based therapy. (Prior exposure requirement restored)

Pancreatic cancer

• 5/15/1996: Initial FDA approval for first-line treatment for patients with locally advanced (nonresectable Stage II or Stage III) or metastatic (Stage IV) adenocarcinoma of the pancreas; also indicated for patients previously treated with 5-FU.

Also known as

• Code name: LY-188011
• Generic name: difluorodeoxycytidine hydrochloride, gemcitabine hydrochloride
• Brand names: Gemcite, Gemzar, Infugem