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Treatment Name: Gemcitabine (Gemzar®)

Gemcitabine (Gemzar®) is a Chemotherapy Regimen for Pancreatic Cancer

How does gemcitabine (Gemzar®) work?
Gemcitabine is designed to target and kill cancer cells by inserting itself into the DNA of a pancreatic cancer cell, but not allowing cancer DNA to replicate. This prevents the cancer cell from growing and dividing, and causes it to die.

Goals of therapy:
Gemcitabine is given to help decrease symptoms from pancreatic cancer such as pain, decreased appetite, and weight loss. If the disease is not metastatic, it may be given after surgery with the goal of cure. If the disease is metastatic, it is not commonly given with the goal of cure.

Schedule

  • Gemcitabine intravenous (I.V.) infusion over 30 minutes on Days 1, 8, and 15
    • NOTE: if gemcitabine is infused over longer than 30 minutes, it can cause increased toxicity and side effects

Estimated total infusion time for this treatment:

  • Up to one hour for each treatment day
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

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.

Gemcitabine is repeated every 28 days. This is known as one Cycle. Each cycle may be repeated up to six times, depending upon the stage of the disease and if its given with or without radiation. Duration of therapy may last up to six months, depending upon response, tolerability, and number of cycles prescribed.

Click here for the common gemcitabine (Gemzar®) starting doses.

Side Effects

In clinical studies, the most commonly reported gemcitabine (Gemzar®) side effects are shown here. Side effects sometimes have percentage ranges [example: 31 – 62%] because they differed between clinical studies:

Roughly 6% of patients discontinue treatment due to unacceptable side effects.

NOTE: Hair loss from gemcitabine (Gemzar) is almost always mild, not obvious from a distance, and seen only on close inspection. A different hair style can help cover some hair loss, and a wig or hair piece is usually not required. NO patient in the clinical study reported above experienced total hair loss from gemcitabine.

NOTE: Nausea or vomiting are likely to be experienced by fewer than the 64% listed above because this data is from a study completed before newer anti-nausea pre-medicines currently being used on patients today.

Side effect videos Side Effect Videos
AnemiaAnemiaNausea and VomitingNausea and VomitingBleedingBleedingNeutropenic FeverNeutropenic FeverDiarrheaDiarrheaHair LossHair LossConstipationConstipationPainPainFatigue Fatigue

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each weekly treatment or more frequently if recommended by your doctor. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order. Tumor markers such as CEA and CA19-9 may also be checked periodically as well.

How often is imaging needed?
Imaging may be checked before treatment and every 8 weeks or as recommended by your doctor. Imaging may include: ultrasounds of the abdomen, magnetic resonance imaging (MRI), or computerized tomography (CT) scans.

How might blood test results/imaging affect treatment?
Depending upon the results your doctor may advise to continue gemcitabine as planned, delay treatment, or switch therapy.

ChemoExperts Tips

  • 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 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 Gemcitabine (Gemzar®). Depending upon your income, they may be able to help cover the cost of:

  • 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 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 Gemcitabine (Gemzar®)

Individual Drug Label Information

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

1) Burris III HA, Moore MJ, Andersen J, et al. Improvements in Survival and Clinical Benefit With Gemcitabine as First-Line Therapy for Patients With Advanced Pancreas Cancer: A Randomized Trial. J Clin Oncol. 1997;15:2403-2413.

2) Oettle H, Post S, Neuhaus P, et al. Adjuvant Chemotherapy With Gemcitabine vs Observation in Patients Undergoing Curative-Intent Resection of Pancreatic Cancer. JAMA. 2007;297:267-277.

Created: January 14, 2017 Updated: August 13, 2018

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.

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 gemcitabine (Gemzar®) starting doses

Gemcitabine 1000 mg/m2 intravenous (I.V.) infusion over 30 minutes on Days 1, 8, and 15 of a 28-day Cycle.

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1) Burris III HA, Moore MJ, Andersen J, et al. Improvements in Survival and Clinical Benefit With Gemcitabine as First-Line Therapy for Patients With Advanced Pancreas Cancer: A Randomized Trial. J Clin Oncol. 1997;15:2403-2413.

2) Oettle H, Post S, Neuhaus P, et al. Adjuvant Chemotherapy With Gemcitabine vs Observation in Patients Undergoing Curative-Intent Resection of Pancreatic Cancer. JAMA. 2007;297:267-277.

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

What is metastatic disease?

Metastatic disease is when cancer cells have spread from their primary (original) location to other parts of the body and started more tumor(s).