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Treatment Name: Carboplatin + Gemcitabine (Gemzar®)

Carboplatin + Gemcitabine (Gemzar®) is a Chemotherapy Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)

How does carboplatin + gemcitabine work?
Each of the medications in carboplatin + gemcitabine are chemotherapy drugs designed to both slow the growth of and kill lung cancer cells.

Goals of therapy:
Carboplatin + gemcitabine (or "carbo/gem") is given to shrink exisiting lung cancer nodules, slow the spread of lung cancer and decrease symptoms. If the cancer cannot be removed with surgery or radiation, carbo/gem is not commonly given with the goal of cure.

Schedule

  • Carboplatin intravenous (I.V.) infusion over 30 - 60 minutes on Day 1
  • Gemcitabine I.V. infusion over 30 on Days 1, 8, and 15
  • Each cycle is repeated every 28 days; no chemotherapy is scheduled on Day 22

Estimated total infusion time for this treatment:

  • Up to three hours for Day 1 and up to two hours for Days 8 and 15 of each cycle
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and I.V. fluids, such as hydration, may add more time

Carboplatin + gemcitabine is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick.

The entire carboplatin + gemcitabine regimen is repeated every 28 days. This is known as one Cycle. Each cycle may be repeated up to 4 times. Duration of therapy depends upon response, tolerability, and number of cycles prescribed

Click here for common carboplatin + gemcitabine starting doses.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with carboplatin + gemcitabine are shown here:

  • Nausea/Vomiting (69%)
  • Hair loss (52%, a wig, bandana or hat may be desired)
  • Increased bruising or bleeding risk [low platelets; thrombocytopenia] (51%)
  • Low white blood cells [neutropenia, increased infection risk] (50%)
  • Mouth sores (mild to moderate, 37%)
  • Flu-like symptoms (33%)
  • Water retention (21%)
  • Rash (20%)
  • Tingling or numbness in fingers or toes (20%)
  • Anemia [low red blood cells] (15%)
  • Ringing in ears (10%; temporary in 7%, continuous in 3%)
  • Kidney injury (5%)
  • Continuous loss of some hearing (4%)
  • Temporary loss of some hearing (2%)

Disease-related symptoms may include:

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingHair LossHair LossBleedingBleedingNeutropenic FeverNeutropenic FeverAnemiaAnemiaFatigue Fatigue ConstipationConstipationDiarrheaDiarrheaBlood ClotsBlood ClotsPainPain

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment, after cycle 2, after cycle 4, or anytime during treatment at your doctor’s discretion. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue carboplatin + gemcitabine as planned, delay treatment for a low white blood cell count or low platelet count, or switch to an alternative therapy.

ChemoExperts Tips

  • Carboplatin hypersensitivity reactions can be severe. This reaction is most common after 8 or 9 cycles of carboplatin, but can happen after any dose. Some institutions may use "desensitization protocols" to allow a person to keep receiving carboplatin after they have had a reaction. Desensitization is used if someone is receiving a good response from carboplatin, or if few other chemotherapy options are available
  • Patients and their caregivers should be counseled to recognize the signs and symptoms of drug reactions and reports them immediately, even after they have left the clinic
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for lung cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications.

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Carboplatin + Gemcitabine (Gemzar®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Carboplatin + Gemcitabine (Gemzar®). Depending upon your income, they may be able to help cover the cost of:

  • Carboplatin
  • Gemcit­abine

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Carboplatin + Gemcitabine (Gemzar®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Carboplatin + Gemcitabine (Gemzar®)

Individual Drug Label Information

Carboplatin (Paraplatin®)

  • Carboplatin is an intravenous infusion 
  • This medication is dosed based on your kidney function. If your kidney function improves or worsens during therapy, your dose may need to be adjusted
  • This drug should not be used during pregnancy, it may cause fetal harm
General Carboplatin (Paraplatin) Side Effects:  
  • Low red blood cells, low white blood cells, and most commonly, low platelets can be occur
  • Nausea and vomiting is common but can be prevented by taking certain pre-medications
  • Hair loss
  • Constipation and/or diarrhea
  • Pain
  • Allergic reactions to carboplatin can occur. These typically are not seen until after the 6th dose of carboplatin is given 
  • Can cause liver damage at high doses 
  • May cause kidney damage or hearing loss if combined with other medications that also cause these side effects 
  • Click on the carboplatin (Paraplatin) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossBleedingBleedingConstipationConstipationPainPainAnemiaAnemia

See DailyMed package insert.

Gemcit­abine (Gemzar®)

  • Gemcitabine is an intravenous infusion
  • Toxicity is increased with infusion time greater than one hour or dosing more than once per week
  • Liver and kidney function should be monitored regularly to minimize toxicity
  • Dosage adjustments may be required for low white blood cells, low platelets, or liver dysfunction
  • Known to cause fetal harm; this drug should be avoided during pregnancy 
General gemcitabine (Gemzar) side effects
  • Low red and white blood cells
  • Low blood platelets
  • Fever
  • Nausea & vomiting
  • Increased liver enzymes and toxicity
  • Diarrhea
  • Bleeding
  • Skin rash
  • Pins and needles tingling & pain in hands and feet
  • Hair loss
  • Kidney problems and fluid retention
  • Although rare, can cause serious lung injury or shortness of breath
  • Click on the gemcitabine (Gemzar) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossBleedingBleedingPainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

Danson S, Middleton MR, O'Byrne KJ, et al. Phase III trial of gemcitabine and carboplatin versus mitomycin, ifosfamide, and cisplatin or mitomycin, vinblastine, and cisplatin in patients with advanced nonsmall cell lung carcinoma. Cancer. 2003;98:542-553.

Created: July 8, 2016 Updated: October 5, 2018

What is Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)?

What is Non-Small Cell Lung Cancer?
A disease of the tissue found in the lung.  Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Known causes include smoking and exposure to environmental toxins.  The stage of NSCLC can vary at diagnosis and throughout treatment.  Stages include stage I, II, III, and IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does "Cure" mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Common Starting Doses

  • Carboplatin Target AUC 5* intravenous (I.V.) infusion over 30 - 60 minutes on Day 1
  • Gemcitabine 1000 mg/m2 I.V. infusion over 30 on Days 1, 8, and 15

Each cycle is repeated every 28 days; no chemotherapy is scheduled on day 22

* Target AUC 5 is calculated using the Calvert formula. Total Dose (mg) = (Target AUC) x (GFR + 25), where the GFR does not exceed 125 mL/min

-The dose may be capped at 750 mg, depending upon your Doctor's recommendation

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium