As someone who responded to Gemzar (gemcitabine) monotherapy as first line for Stage IV NSCLC and has been on it 16 months, I have been following Catdancer’s reportage of her husband D’s extraordinary journey with Gemzar to NED status. It gave me hope and a positive attitude that it could happen for me despite how extensive my cancer was compared to D's.
The last CT on 9/28/12 was “Stable” but mixed, with troubling comments by the radiologist. He saw “subtle lucencies” in my pelvis and sacrum, a potential precursor of lytic tumors or bone mets, and “slight” increase in size of mediastinal lymph nodes “raising suspicion for slight overall worsening of disease.”
I had asked Catdancer if D ever had just a stable or several stables on his way to NED, or was it slow but consistent shrinkage. She generously responded that he did have just stable scans, and even one that looked like progression and the onc considered stopping. She will never know what that meant to me.
Well, I just got hold of the “Findings” and “Expression” from my Jan. 10, 2013 PET/CT: Here is only the cancer related part of the Impression, sans prostate size, etc:
"1. Reduction in size in the right upper lung mass and reduction in hypermetabolic activity suggesting further improvement (SUV 4.3 on PT/CT 1/3/12, now SUV 3.2 on PT/CT 1/10/13)
2. small mediastinal lymph nodes again noted demonstrated no abnormal hypermetabolic actitivy."
.
I have no hypermetabolic activity anywhere, including all lymph nodes, and the primary tumor shrunk about 18% (at least according this radiologist’s measurements). I am blessed. Thanks Catdancer and D, you helped me do battle and I have at least bought more time. My first onc had me dead my March, 2012. Awaiting D’s next NED scan.
Reply # - January 15, 2013, 09:45 AM
Reply To: Gemzar monotherapy Update
YAY slimer! How great it is to be a part of such wonderful news. I know we shouldn't let our 2 unusual stories of long term continued efficacy seem like it's the gemzar, it probably has more to do with the biology of the cancers but gemzar's certainly doing its job for us. We should celebrate our good fortune.
D and I have moved into scanxiety mode as we wait for the date to come but it's still a couple weeks away. Of course I'll keep you posted.
Wow again, congratulations on the good news. Enjoy it and I hope you continue to receive such reports.
Janine
Reply # - January 15, 2013, 08:35 PM
Reply To: Gemzar monotherapy Update
I'm very happy to hear those good results. I hope you're feeling well on it, as most of my patients have on single agent gemcitabine.
-Dr. West
Reply # - January 16, 2013, 02:33 AM
Reply To: Gemzar monotherapy Update
That's terrific news, Slimer. My father just started single agent Gemzar second line after a year on Alimta and testing negative for mutations. I hope Gemzar buys him a bit more time. Congratulations and I hope it works for you for a long time!
Jazz
Reply # - January 16, 2013, 09:51 AM
Reply To: Gemzar monotherapy Update
Jazz, I very much hope your father responds. At least he will not be beat up too much, even less than the Alimta, particularly the fatigue. Apropos of what Dr. West said, I once asked my onc what is so special about me that I have no noxious side-effects and feel absolutely normal on Gemzar, 3 weeeks on and one off. And he answered me bluntly: '"There is nothing special about you, I have 90 year old ladies who get their Gemzar infusion and then go on to their cards games." And I do know first hand what other chemos do to you because I had one, and only one, infusion of Cisplatin/Gemzar and then quit. My current onc said I was so diseased that I needed to do something and suggested that I could handle Gemzar alone, "off label" treatment, with good Quality of Life, which is everything to me, He added, "maybe you'll get lucky." Well I got lucky and the man saved my life.
I have always wondered what the explanation is for Gemzar's relative gentleness compared to taxol or navelbine, or any of the other non-platinum chemos. It would change everything for patients, much as the new drugs dealing with nausea have, if new chemos could match the tolerability of Gemzar. It really whacks your good cells, but unless it is extreme, you don't notice. I wish you and your Dad the best of luck.
Reply # - January 16, 2013, 05:22 PM
Reply To: Gemzar monotherapy Update
Thanks! Apparently Gemzar is referred to as "the new water" by some oncologists. I can attest to that, as I would go to Costco after infusion, even on Day 8, in combination with carboplatin and Avastin! I had some shortness of breath when blood counts went down on Day 14, but absolutely no comparison to the pain of taxanes!
Reply # - January 16, 2013, 06:43 PM
Reply To: Gemzar monotherapy Update
My Mom had absolutely no side-effects with Gemzar. So, yes, I can definitely jump on this band wagon. . .
Laya
Reply # - January 18, 2013, 04:31 PM
Reply To: Gemzar monotherapy Update
I'm wondering about the use of gemcitibine as a single agent. In talking with my oncologist today, she mentioned doing carboplatin AND gemzar. She indicated that the doublet is what is usual. For someone as heavily treated as me but who is still in decent shape and five years out from (10) carboplatin treatments, I'm curious as to what might be expected from the doublet vs the monotherapy. I like the sound of gemzar alone but would be willing to try carbo again if the results might be worth it.
Reply # - January 18, 2013, 09:19 PM
Reply To: Gemzar monotherapy Update
The reason that a platinum-gemcitabine doublet is more usual is that gemcitabine is most commonly used in the first line setting, paired with a platinum. It certainly can be used in second or third line or later, but it's far less well studied there and hasn't clearly been shown to confer a significant benefit after first line.
It's certainly very reasonable to consider a doublet for an individual patient in a special circumstance -- such as being many years out from prior doublet therapy -- but the trials that have compared doublet therapy to single agent chemo after first line haven't shown a survival benefit for the doublet. It's fair to say that these were a more general population and that results could be different in a more unique situation, but because of that, it's not possible to say what could really be expected.
Good luck.
-Dr. West