Full Answer
What is gemcitabine and Cisplatin combination chemotherapy?
Gemcitabine and Cisplatin is a highly effective combination chemotherapy in patients with advanced cancer of the gallbladder Am J Clin Oncol. 2003 Apr;26(2):174-7.doi: 10.1097/00000421-200304000-00015.
What are the side effects of gemcitabine plus cisplatin?
In clinical studies, the most commonly reported gemcitabine plus cisplatin side effects are shown here: Nausea and vomiting (75%) Low white blood cells [neutropenia] (35%) Increased bleeding risk [Low platelets; thrombocytopenia] (31%) Kidney injury (26%)
How often do you give cisplatin and gemcitabine?
In almost all studies, gemcitabine was administered intravenously at a dose of 1,000 to 1,250 mg/m2 on day 1 and day 8 of a 21-day cycle. The dose of cisplatin was more variable, ranging from 20 to 80 mg/m2, and was usually administered either once (day 1) or twice (days 1 and 8) per cycle.
Is there a difference between S-1 plus cisplatin and gemcitabine-cisplatin?
However, in a meta-analysis of these two RCTs, significantly greater OS and PFS were observed (p < 0.001) in the gemcitabinecisplatin group than in the gemcitabine only group [37]. In the RCT by Kang et al. [27], no significant differences in OS or PFS were observed between gemcitabine-cisplatin and S-1 plus cisplatin groups.
What is GEMCITABINE used for?
Why is chemotherapy better than single drugs?
About this website
How many cycles of gemcitabine and cisplatin can you have?
You usually have between 4 to 6 cycles of treatment taking from 3 to 6 months.
How effective is gemcitabine and cisplatin?
Median time to progression was 28 weeks and median overall survival was 42 weeks. Toxicity was easily manageable, and no treatment-related deaths occurred. We conclude that gemcitabine in combination with cisplatin may be one of the most effective therapies for patients with advanced gallbladder cancer.
What is gemcitabine plus cisplatin?
Interpretation. Gemcitabine plus cisplatin prolongs progression-free survival in patients with recurrent or metastatic nasopharyngeal carcinoma. The results establish gemcitabine plus cisplatin as the standard first-line treatment option for this population.
Does Chemo work for cholangiocarcinoma?
Chemo might shrink the tumor enough to improve the odds that surgery will be successful. This is called neoadjuvant treatment. As part of the liver transplant process: Chemo may be used to keep bile duct cancer under control while waiting for a liver transplant.
What is the most common side effect of cisplatin?
The following side effects are common (occurring in greater than 30%) for patients taking Cisplatin: Nausea and vomiting. Nausea may last up to 1 week after therapy. Anti-nausea medication is given before the infusion, and a prescription is also given for use after.
What are the side effects of gemcitabine?
Side EffectsBlack, tarry stools.bloating or swelling of the face, arms, hands, lower legs, or feet.blood in the urine or stools.chest pain.cloudy urine.coughing up blood.difficult or labored breathing.difficulty in moving.More items...•
What are the long term effects of cisplatin?
Cisplatin (CDDP) is a frequently employed chemotherapeutic drug both in curative and palliative settings. When cancer patients are cured due to CDDP therapy, they unfortunately often experience severe long‐term side effects including irreversible hearing loss (ototoxicity) and permanent neuronal and renal damage.
Is cisplatin a strong chemo drug?
Presently, cisplatin is one of the most powerful chemotherapeutic drugs used for the treatment of ovarian cancer; even though resistance is typical [20]. In ovarian germ cell cancer, the use of cisplatin brings about high response rates [21].
How effective is gemcitabine?
Since 1997, gemcitabine therapy has been the standard first-line treatment for patients with unresectable locally advanced or metastatic pancreatic cancer. Among patients with metastatic disease, the 5-year survival rate is only 2%,1 and 1-year survival rates of 17 to 23% have been reported with gemcitabine.
Does anyone survive cholangiocarcinoma?
Cholangiocarcinoma (bile duct cancer) is a deadly disease. Even when it's detected early, the five year survival rates for people with this cancer is less than 25%.
How many cycles of chemo does it take for cholangiocarcinoma?
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
What is the life expectancy with cholangiocarcinoma?
Cholangiocarcinomas arise from the epithelial cells of intrahepatic and extrahepatic bile ducts. They generally have a very poor prognosis. Many studies report a dismal median survival of approximately 6 months.
Gemcitabine + Cisplatin - Bladder Cancer | ChemoExperts
Long-term side effects of anti-cancer medications are specific to each medication. Not all anti-cancer or chemotherapy medications have long-term side effects, but several have been associated with memory difficulties (sometimes called "chemo brain"), heart problems, diabetes, numbness or tingling in hands and feet, fertility problems, or fatigue.
CISPLATIN and GEMCITABINE for biliary tract cancers
CISPLATIN and GEMCITABINE for biliary tract cancers CISPLATIN-GEMCITABINE-protocol-CRP09-UGI008 v1.5 Page 1 of 3 Issue Date 13/03/2018 Expiry Date: 13/03/2021
Drug sequence with gemcitabine - Oncology Nurse Advisor
In some instances, sequencing data for one agent is applied to all agents in that class (eg, the data with cisplatin and paclitaxel is extrapolated to carboplatin and paclitaxel regimens ...
NCCN Update in Urothelial Bladder Cancer Highlights Checkpoint ...
Add urothelial bladder cancer to the list of cancer types that are seeing success with immunotherapy, despite some early failures. The advent of checkpoint inhibitors has altered the treatment landscape in this disease, said Arlene O. Siefker-Radtke, MD, of The University of Texas MD Anderson Cancer Center, during last week’s National Comprehensive Cancer Network (NCCN) Virtual Annual ...
Gemcitabine and cisplatin-based combination chemotherapy in advanced ...
Gemcitabine, an anti-metabolite, has some activity in hepatocellular carcinoma (HCC) in terms of responses and median survival.To analyze our experience with the use of gemcitabine in combination with cisplatin in HCC with respect to response, toxicity ...
Gemcitabine Uses, Side Effects & Warnings - Drugs.com
What is gemcitabine? Gemcitabine is used to treat cancers of the pancreas, lung, ovary, and breast. Gemcitabine is sometimes given with other cancer medicines, or when other cancer treatments did not work or have stopped working.
Is gemcitabine a combination?
Gemcitabine and Cisplatin is a highly effective combination chemotherapy in patients with advanced cancer of the gallbladder. We evaluated the efficacy and toxicity of gemcitabine with or without cisplatin in 11 chemonaive patients with histologically confirmed advanced gallbladder cancer. All were symptomatic and had stage IV disease.
Is gemcitabine safe for gallbladder cancer?
Toxicity was easily manageable, and no treatment-related deaths occurred. We conclude that gemcitabine in combination with cisplatin may be one of the most effective therapies for patients with advanced gallbladder cancer. If confirmed by others, it may provide an important therapeutic option in managing these patients who otherwise have ...
What is the primary objective of the systematic review of gemcitabine-cisplatin?
The primary objective of this systematic review is to present collated evidence from randomized and nonrandomized prospective studies for the efficacy of gemcitabine-cisplatin in patients with advanced or meta static BTC . We chose to focus on the gemcitabine-cisplatin combination, rather than other chemotherapeutic regimens, because of its current status as the treatment of choice for BTC and because the relatively large number of studies provide an opportunity to explore potential subgroup differences in efficacy and safety. As such, the secondary objectives of the review are to assess whether the efficacy of gemcitabine-cisplatin is influenced by primary tumor site, disease stage, or geographic region, and to present collated evidence from prospective and retrospective studies of toxicities , including whether these toxicities are influenced by the dose or regimen used.
How much gemcitabine is given?
Sample sizes ranged from 10 [21] to 410 [17] participants; 912 participants received gemcitabine-cisplatin. In almost all studies, gemcitabine was administered intravenously at a dose of 1,000 to 1,250 mg/m2on day 1 and day 8 of a 21-day cycle. The dose of cisplatin was more variable, ranging from 20 to 80 mg/m2, and was usually administered either once (day 1) or twice (days 1 and 8) per cycle.
What databases were searched for gemcitabine?
The following databases were searched on 5 December 2013: MEDLINE via PubMed (1946-search date); EMBASE (1966-search date); ClinicalTrials.gov results database (2008-search date); and abstracts from American Society of Clinical Oncology, European Society for Medical Oncology (ESMO), ESMO Gastrointestinal Cancer, and European CanCer Organisation conferences (2009-2013). Free-text terms and medical subject heading (MeSH) or EMTREE terms were used where possible to search for gemcitabine (‘gemcitabine’ and ‘Gemzar’), cisplatin (‘cisplatin’), and BTC (‘biliary tract cancer’ and ‘biliary tract neoplasms’), including specific BTC types and tumor sites (‘gallbladder’, ‘bile duct’, ‘papilla of Vater’, ‘ampulla of Vater’, ‘Klatskin’, and ‘cholangiocarcinoma’). Searches were conducted using truncation symbols and Boolean operators (AND, OR) as needed. There were no restrictions on publication type or language, although the search output was restricted to human studies where possible.
What is BTC in the biliary tract?
Biliary tract cancer (BTC) refers to a group of cancers of the biliary tract , including gallbladder cancer, cholangiocarcinoma of intrahepatic and extrahepatic bile ducts, and cancers of the ampulla and papilla of Vater [1,2]. Despite its relatively rarity, the incidence of BTC varies widely in different geographic regions, with the lowest incidence rates in Western countries, including the United States and western Europe, and the highest rates in Asia and Latin America [3]. Gallbladder cancer is the most common type of BTC; however, the proportion of BTC tumors that originate in the gallbladder varies geographically [3,4]. Most patients with BTC are diagnosed at a late stage, in part because there are few, if any, specific symptoms [5]. Surgery is the only curative treatment; however, most patients are ineligible for surgery, either because their tumors are unresectable or because they have other comorbidities that preclude surgical intervention [2,5]. The prognosis for patients with advanced (unresectable and/or metastatic) BTC is very poor, and most survive for less than a year after diagnosis [5,6].
Does gemcitabine help with cancer?
Evidence suggests that combined gemcita bine-cisplatin chemotherapy extends survival in patients with advanced biliary tract cancer (BTC). We conducted a systematic review in order to collate this evidence and assess whether gemcitabine-cisplatin efficacy is influenced by primary tumor site, disease stage, or geographic region, and whether associated toxicities are related to regimen. MEDLINE (1946-search date), EMBASE (1966-search date), ClinicalTrials. gov (2008-search date), and abstracts from major oncology conferences (2009- search date) were searched (5 Dec 2013) using terms for BTC, gemcitabine, and cisplatin. All study types reporting efficacy (survival, response rates) or safety (toxicities) outcomes of gemcitabine-cisplatin in BTC were eligible for inclusion; efficacy data were extracted from prospective studies only. Evidence retrieved from one meta-analysis (abstract), four randomized controlled trials, 12 nonrandomized prospective studies, and three retrospective studies supported the efficacy and safety of gemcitabine-cisplatin for BTC. Median overall survival ranged from 4.6 to 11.7 months, and response rate ranged from 17.1% to 36.6%. Toxicities were generally acceptable and manageable. Heterogeneity in study designs and data collected prevented formal meta-analysis, however exploratory assessments suggested that efficacy did not vary with primary tumor site (gallbladder vs. others), disease stage (metastatic vs. locally advanced), or geographic origin (Asia vs. other). Incidence of grade 3/4 toxicities was not related to gemcitabine dose or cisplatin frequency. Despite individual variation in study designs, the evidence presented suggests that gemcitabine-cisplatin is effective in patients from a diverse range of countries and with heterogeneous disease characteristics. No substantial differences in toxicity were observed among the different dosing schedules of gemcitabine and cisplatin.
Can chemotherapy prolong the life of a patient with BTC?
Although surgery remains the only curative treatment, chemotherapy can extend survival of patients with BTC [2]. For example, in an early randomized controlled trial (RCT) of chemotherapy in BTC and pancreatic cancer, treatment with 5-fluorouracil and leucovorin, with or without etoposide, increased median survival of patients with BTC to 6.5 months, compared with 2.5 months achieved with best supportive care [7]. Historically, due to the relative rarity of BTC, conduct of clinical studies of potential therapies has been difficult, and physicians have often used chemotherapy regimens that benefit patients with other gastrointestinal cancers, particularly pancreatic cancer. One such chemotherapeutic agent is gemcitabine, which is a standard of care for patients with advanced, unresectable pancreatic cancer [8], and has been approved by the Food and Drug Administration (FDA) as monotherapy for these patients [9]. In pancreatic cancer, additional survival benefit can be achieved by combining gemcitabine and a platinum agent, such as cisplatin; however, combination therapy may be associated with greater toxicity than gemcitabine monotherapy [10].
Is gemcitabine a combination therapy?
Evidence of the efficacy of several gemcitabine-based combination therapies, such as gemcitabine-oxaliplatin and combinations involving targeted therapies, in patients with BTC has been reported [2,11-14], with the most substantial evidence reported for gemcitabine combined with cisplatin.
What is the purpose of gemcitabine and cisplatin?
Each of the medications in the gemcitabine and cisplatin (also known as gem/cis) regimen are designed to kill or slow growth of bladder cancer cells. Goals of therapy: Cisplatin plus gemcitabine is given to shrink bladder tumors and decrease symptoms from bladder cancer. It can be given either after surgery to eliminate microscopic cells, ...
How often is Gemcitabine used?
Gemcitabine + cisplatin is repeated every 21 or 28 days. This is known as one Cycle. Each cycle may be repeated up to four times if the disease is not metastatic. If the disease is metastatic, then each cycle may be repeated up to 6 times. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
How long does it take to infuse Gemcitabine?
Gemcitabine intravenous (I.V.) infusion over 30 minutes on Days 1, 8, and 15
Can you give cisplatin before surgery?
It can be given either after surgery to eliminate microscopic cells, or it can be given before surgery to shrink the size of the bladder tumor and minimize the size of the surgery. If there is no metastatic disease (cancer is limited to bladder only and not other parts of the body), cisplatin plus gemcitabine are commonly given with the goal ...
Can you give Gemcitabine in an outpatient infusion?
Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time. Gemcitabine (Gemzar) and cisplatin are usually given in an outpatient infusion center, allowing the person to go home afterwards.
Does Cisplatin damage kidneys?
Cisplatin can possibly damage the kidneys. Be sure to maintain good hydration to lessen the risk of experiencing kidney damage. 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.
Does Medicare preauthorize Gemcitabine?
Medicare and Medicaid patients (Patients 65 years or older): The clinic providing treatment will likely pre-author ize medications and immune therapies such as Gemcitabine (Gemzar®) + Cisplatin and are the best source to help you understand drug cost.
How long does it take for cisplatin to go into your bloodstream?
Day 8 - bladder and bile duct cancer only. You have cisplatin as a drip into your bloodstream over 30 minutes. Day 9 to 21. You have no treatment. You then start a new cycle of treatment.
How long does GC chemotherapy take?
You usually have GC chemotherapy as cycles of treatment. Each cycle takes 3 weeks. You usually have between 4 to 6 cycles of treatment taking from 3 to 6 months. You have gemcitabine as a drip into your bloodstream over 30 minutes. You have cisplatin as a drip into your bloodstream over 1 to 4 hours.
How to control antisickness?
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help. It is important to take anti sickness medicines as prescribed even if you don’t feel sick.
What is GC in cancer?
GC is the name of a chemotherapy combination that includes: gemcitabine. cisplatin. It is a treatment for a number of different types of cancer.
Can cancer drugs interact with other drugs?
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Does gemcitabine cause lung injury?
Different patterns of lung injury may be related to gemcitabine. A rapid response following the administration of corticosteroids would mean the respiratory problem was probably due to a hypersensitivity reaction. [ Ref]
Is grade 3/4 thrombocytopenia more common in older women?
Grade 3/4 thrombocytopenia was more common in the elderly, especially older women. The risk for thrombotic thrombocytopenic purpura increases as the cumulative dose of gemcitabine approaches 20,000 mg/m2.
Does gemcitabine need medical attention?
Side effects not requiring immediate medical attention. Some side effects of gemcitabine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine.
Does gemcitabine cause tarry stool?
Along with its needed effects, gemcitabine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor or nurse immediately if any of the following side effects occur while taking gemcitabine: More common. Black, tarry stools.
Is gemcitabine a single agent?
Out of the five reported cases of distal ischemic changes, four of those case related to combination chemotherapy with cisplatin and gemcitabine, while one case was of gemcitabine as a single agent in first-line therapy. [ Ref]
What is optimal sequencing of chemotherapy?
Optimal sequencing of many chemotherapy regimens is determined using preclinical models (eg, cancer cell lines in research labs), rather than studying the effects of different sequences of administration in humans.
What are the factors that affect the sequence of chemotherapy?
Multiple factors affect the sequence of chemotherapy agents, such as the pharmacokinetic properties of the medication (eg, does it undergo extensive metabolism or is the agent extensively protein bound). 1 The effectiveness of drugs with cell cycle-specific mechanisms of action (ie, is the drug only active against cells at a specific point in their growth and division) may be heavily influenced by the sequence of administration, as the order of administration may reduce or increase each drug’s cytotoxicity.
What should chemo orders reflect?
Chemotherapy orders should reflect the intended sequence of administration for agents in the prescribed regimen. If there is a question regarding sequencing for a regimen for treatment of a specific cancer, consult your pharmacist to clarify the appropriate order.
Does paclitaxel affect cisplatin?
Other studies have demonstrated that the sequence of administration may influence the adverse effects patients experience with a regimen. One well-known example of this is administration of cisplatin and paclitaxel (Taxol); when cisplatin is given before paclitaxel, patients experience increased neutropenia. This effect is reduced when paclitaxel is administered first (without reducing the efficacy of the regimen).
Is sequencing data applied to all agents?
In some instances, sequencing data for one agent is applied to all agents in that class ( eg, the data with cisplatin and paclitaxel is extrapolated to carboplatin and paclitaxel regimens).
When to reintroduce m ipilimumab?
m Ipilimumab reintroduction may be considered for select patients who did not experience significant systemic toxicity during prior ipilimumab therapy and who relapse after initial clinical response or have progression after stable disease > 3 months.
What is the best medicine for colitis?
d Infliximab 5 mg/kg is preferred for treatment of severe immune- related colitis that does not resolve with high-dose steroids. A single dose of infliximab is sufficient to resolve immune-related colitis in most patients.
Can IL-2 be used for brain metastases?
n High-dose IL should not be used in patients with inadequate organ reserve, poor performance status, or untreated or active brain metastases. IL-2 may be considered for patients with small brain metastases and without significant peritumoral edema.
Is ipilimumab safe for patients?
e Ipilimumab has the potential for significant immune-mediated complications. Although no longer required by the FDA, the Risk Evaluation and Mitigation Strategy program and/or experience in use of the drug as well as resources to follow the patient closely are essential for safe use of ipilimumab. It should be used with extreme caution, if at all, in patients with underlying immune disorders.
What is GEMCITABINE used for?
GEMCITABINE-CISPLATIN is used to treat: Biliary tract cancer. Bladder cancer. Cervical cancer. Malignant mesothelioma. Non-small cell lung cancer (NSCLC). Ovarian cancer. Pancreatic cancer. This combination may also be used with other drugs or treatments or to treat other types of cancer.
Why is chemotherapy better than single drugs?
Chemotherapy is often given as a combination of drugs. Combinations usually work better than single drugs because different drugs kill cancer cells in different ways. Each of the drugs in this combination is approved by the Food and Drug Administration (FDA) to treat cancer or conditions related to cancer.