Treatment Name: Cisplatin + Gemcitabine (Gemzar®)
Cisplatin + Gemcitabine (Gemzar®) is a Chemotherapy Regimen for Pancreatic Cancer
How does cisplatin + gemcitabine work?
Each of the medications in cisplatin + gemcitabine are designed to kill or slow the growth of pancreatic cancer cells.
Goals of cisplatin + gemcitabine therapy:
Cisplatin + Gemcitabine (Gemzar®) is given to shrink tumors and decrease symptoms for a pancreatic cancer patient. It is commonly given with the goal of cure if the disease is not metastatic (not spread outside the area of the pancreas) and when combined with surgery. If the disease is metastatic (spread outside of the pancreas), it is given to relieve symptoms and improve quality of life, not for cure.
Olaparib (Lynparza®) may be given to some patients after at least 16 weeks of therapy with Cisplatin + Gemcitabine. Metastatic pancreatic cancer patients with BRCA mutations who’s disease has not progressed while on Cisplatin + Gemcitabine may be candidates for olaparib maintenance therapy. The goal of olaparib is not cure, but to slow the progression of pancreatic cancer.
How is cisplatin + gemcitabine therapy for pancreatic cancer given?
If the disease is metastatic:
• Cisplatin I.V. infusion over 60 minutes on Days 1 and 15
• Gemcitabine I.V. infusion over 30 minutes on Days 1 and 15
If the disease is not metastatic:
• Cisplatin I.V. infusion over 60 minutes on Day 1
• Gemcitabine I.V. infusion over 30 minutes on Day 1
Estimated total infusion time for this treatment:
- From four to five hours for each treatment. Typically, I.V. hydration is given both before and after cisplatin; I.V. magnesium can add up to two extra hours
- 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
Cisplatin + gemcitabine is usually given in an outpatient infusion center, allowing the pancreatic cancer patient to go home afterwards. On occasion, it may be given in the hospital if someone is too sick.
If given for metastatic disease, cisplatin + gemcitabine is repeated every 28 days. This is known as one Cycle. Each cycle may be repeated until the treatment no longer works or until unacceptable toxicity is experienced. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
If given for disease that is not metastatic, cisplatin + gemcitabine is repeated every 14 days. This is known as one Cycle. Each cycle may be repeated up to four times. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
Click here for the common cisplatin + gemcitabine starting doses.
What are the most common side effects from cisplatin + gemcitabine for pancreatic cancer?
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 common side effects reported for cisplatin + gemcitabine are shown here:
- Nausea and vomiting (89%)
- Low red blood cells [anemia] (78%)
- Pain (52%)
- Hair loss (46%)
- Low white blood cells (46%)
- Diarrhea (33%)
- Low platelets [thrombocytopenia] (30%)
- Blood in the urine (24%)
- Mouth sores (23%)
- Infection (13%)
- Rash (11%)
- Fever (10%)
- Allergic reaction (7%)
- Bleeding (4%)
- Fluid retention in arms and legs (3%)
Watch videos on common cisplatin + gemcitabine therapy side effects below
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood magnesium and potassium levels, plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment then during treatment at the discretion of your doctor. 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 cisplatin + gemcitabine as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to a different therapy.
What are the 4 most important things to know about cisplatin + gemcitabine when receiving treatment?
- Cisplatin can possibly damage the kidneys. Be sure to maintain good hydration to lessen the risk of this problem
- Depending on the results of blood tests (labs) you may need extra I.V. infusions of magnesium or potassium. This can make your total infusion time for the day increase by 2 hours or more. It is best to start this regimen early in the day if extra infusions are common for you
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for pancreatic 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 Cisplatin + 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 Cisplatin + Gemcitabine (Gemzar®). Depending upon your income, they may be able to help cover the cost of:
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 Cisplatin + 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.
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 Cisplatin + Gemcitabine (Gemzar®)
What is Pancreatic Cancer?
A disease of the cells of the pancreas organ. There are different types of pancreatic cancer, the most common being pancreatic adenocarcinoma that accounts for about 85% of cases. This type affects the digestive enzymes produced by the pancreas. Risk factors include: smoking tobacco, obesity, diabetes, and some rare genetic conditions. It can spread to neighboring organs such as: liver, duodenum, stomach, colon, spleen, and kidneys.
Pancreatic cancer is treated with surgery, chemotherapy, radiation therapy, a combination of all these, or sometimes supportive care alone. Surgery can be curative, but it can also be used to reduce tumor size and improve quality of life. The stage can vary at diagnosis and throughout treatment. The Tumor, Node, Metastasis (TNM) staging system is used to stage pancreas cancer. Staging systems describe the extent of cancer throughout the body and help doctors determine which treatments to offer. 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.
Heinemann V, Quietzsch D, Gieseler F, et al. Randomized phase III trial of gemcitabine plus cisplatin compared with gemcitabine alone in advanced pancreatic cancer. J Clin Oncol 2006;24(24):3946-52.
Varadhachary GR, Wolff RA, Crane CH, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol 2008;26(21):3487-95.
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, 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.
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.
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 status, 2) 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
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein
13) Serum glucose
14) Serum calcium
Common starting doses:
If the disease is metastatic:
- Cisplatin 50 mg/m2 intravenous (I.V.) infusion over 60 minutes on Days 1 and 15
- Gemcitabine 1000 mg/m2 I.V. over 30 minutes on Days 1 and 15
* Cycle is 28 Days for metastatic disease
If the disease is not metastiatic:
- Cisplatin 30 mg/m2 I.V. over 60 minutes on Day 1
- Gemcitabine 750 mg/m2 I.V. over 30 minutes on Day 1
* Cycle is 14 days for four cycles, then repeat imaging and tumor marker labs
Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.