What's the latest on Gemcitabine (Gemzar).

Portal Forums Lung/Thoracic Cancer NSCLC Stage IV NSCLC What's the latest on Gemcitabine (Gemzar).

This topic contains 3 replies, has 4 voices, and was last updated by catdander forum moderator catdander forum moderator 4 weeks ago.

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August 22, 2017 at 11:48 am  #1291285    

scohn

Strange to be back posting on the New Questions site…..

So, it is likely my wife will be starting on Gemzar. I would love to know the latest from those who have been treated with it (particularly for NSCLC) as to the types of side effects they have encountered. I am just starting to read up on it, and initially looks like its better in its side effects than many of the other agents stoping cell division. My wife will likely be considering her options, and also wondering if anyone out there has any thoughts on afatinib versus Gemzar. Afatinib is more directed towards the EGFR family of mutations like my wife has (she has HER2), and seems effective, but seems relatively short lasting (6-9 months) with some pretty hefty side effects. Not very familiar with Gemzar but seems to have a much better side-effect profile, but still generally effective for those tumors which did well with other DNA based chemotherapies (like Carbo, which worked well for my wife). In particular, a sense of the range of time people have been on Gemzar, and the degree to which it caused problems with WBC or RBC would be appreciated. Anything else we should be thinking about when we go to the oncologist to discuss our options here?

Thanks!


Wife, lifelong non-smoker, dx 4/24/15 adeno NSCLC stage IV, poorly diff. 2 bone mets, 1 lymph node. HER2 Exon 20 mutation. 6x Carbo/Alimta – >50% reduction in primary tumor, lymph nodes, & bone. Alimta maint. not effective, tumor growth, new liver mets. 11/15 – Opdivo; Not effective-add’l growth. 4/16 – clinical trial drug, large reduction of tumor and mets. 11/16-main tumor growth, liver mets stable. 2/17-All Stable. 8/17- Add’l growth-off trial, 9/17 start Gemzar-large tumor reduction.

August 22, 2017 at 2:13 pm  #1291291    
JimC Forum Moderator
JimC Forum Moderator

Hi scohn,

Dr. West had this to say about the side effect profile of Gemzar:

“It’s typically a 30 minute infusion and, as a single agent, is often very well tolerated, mostly with fatigue and some modestly decreased blood counts, perhaps some mild hair thinning (patients comment on it more often than you’d notice anything from looking across a room), and not usually much nausea or vomiting, especially on its own.

“Results may vary”, and that’s especially true if it or any other anti-cancer therapy is given to someone who has been on many therapies previously, but it’s among the more favorable in the balance of efficacy vs. side effects for plenty of patients.”http://cancergrace.org/lung/topic/gemzar/#post-8322

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

January 25, 2018 at 8:50 am  #1293883    

hopeandfaith

We’ve posted a few times in the past two years, and have appreciated the support, advice and wonderful resources on GRACE.
My father was diagnosed with Stage IV NSCLC, EGFR exon 19 deletion, in 9/15.
He received Tarceva for 9 months, then Tagrisso for the past 18 months, and during that time, he also failed 2 cycles of Carbo/Alimta.
Most recent scans show disease progression in the liver and spine.
Options being discussed include gemcitabine.
Adding to the previous post, we would like to know if there have been any recent studies in the literature looking at the the use of gemcitabine in previously treated NSCLC?
What is the forum’s experience with the combination of Tagrisso and Gemcitabine?
What significant side effects can be expected?
We would greatly appreciate any insight and advice that can be offered.
Thank you in advance for your time. We look forward to your response.

January 25, 2018 at 3:06 pm  #1293886    
catdander forum moderator
catdander forum moderator

Hi hopeandfaith,

I’m sorry to hear your father is progressing. The standard treatment for those who have progressed on tagrisso remains chemotherapy. Two cycles of chemo doublet is not enough to say that he failed the treatment. It normally takes 3 cycles with 4 showing the best outcomes. Many oncs will give up to 6 platinum doublet cycles. If the platinum drug is too difficult for a person to take a single non platinum agent can be given. Alimta is the most used chemo agent for non-squamous nsclc. It has shown to have excellent efficacy and is well tolerated. Gemzar is also used as a single agent or part of a squamous doublet but for non-squamous usually after progression or weakened tolerability on alimta.

Though this isn’t something many lung cancer specialists do some oncologists continue tagrisso after progression outside the brain. They add chemo to tagrisso in hopes it will continue to keep cancer out of the brain. For some combining drugs doesn’t just add the 2 side effects profile together but amplifies them.
There is often short lived efficacy on a tki after a break from tki. Insurance will more than likely balk at paying for both at once.
There is some data suggesting exon 19 is more sensitive to gilotrif than other egfr mutaions. Though it’s probably right to assume your father’s mutation has changed since it’s first biopsy and since T790M was found. Usually biopsies are only done for trials at this junction.
There are trials that may be appropriate for your father.
A 2nd opinion from a large cancer center or teaching hospital with lung specialists at transition times such as this is always a good idea. 2 heads are better than one.

This is an uncut video of the break out session of our patient forum on acquired resistance. At about the 35 min mark a discussion about acquired resistance begins. It’s long but has a tremendous amount of good info, https://youtu.be/iZTr4UnGSoA

I hope something in here helps,
Janine

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