Gemzar (Gemcitabine)

Gemcitabine, trade name Gemzar®, is an experimental drug that is being considered for use in combination with cisplatin in chemotherapy for the treatment of mesothelioma. Gemcitabine is an anti-metabolite that prevents cells from making or repairing the genetic material known as DNA. Gemcitabine is currently used in the treatment of lung, breast, bladder and pancreatic cancers. In a clinical trial of mesothelioma patients, the gemcitabine/cisplatin combination showed promising results. Patients showed a 26% improvement in breathing, pain reduction and weight gain. Gemcitabine is a white powder that turns into a colorless fluid when it is dissolved. It is administered as an infusion through the vein or through a line that is inserted under the skin and into a vein near the collarbone or in the crook of the arm. Gemcitabine offers some side effects that will vary depending upon the patient. If patients are taking other medications in addition to chemotherapy treatments, the other medications may interfere with treatment. Patients should discuss this with their doctors. Chemotherapy may also affect fertility. Patients are advised to use reliable contraception during and for a few months following treatment as conception during this time frame may lead to damage for a developing fetus. Some of the most common side effects of gemcitabine may include anemia, bruising, bleeding, fluid retention, flu-like conditions, liver problems, loss of appetite, nausea, vomiting, resistance to infection, skin changes, tiredness and weakness. Less common side effects may include breathlessness, diarrhea, hair loss, sore mouth, mouth ulcers and taste alteration. The following tables outline the most and less common side effects of gemcitabine, respectively.

Most Common Side Effects of Gemcitabine
Side Effect	Symptom	Solution
Anemia	Tiredness and breathlessness indicate that a patient may be suffering anemia, which is caused by a reduction in red blood cells.	A blood transfusion may be necessary if red blood cell counts become too low.
Bruising and bleeding	A reduction in platelets causes the blood to clot. Nosebleeds, blood spots, skin rashes, bleeding gums or any other form of bleeding or bruising may indicate a reduction in the body’s ability to produce blood platelets.	Patients should consult their doctors of symptoms.
Fluid retention	Swelling of the ankles or breathlessness.	Patients should consult their doctors of symptoms.
Flu-like conditions	High temperature along with headaches, aching joints and aching muscles.	Patients should consult their doctors if high temperatures persist.
Liver problems	Changes in they way the liver works.	The liver will return to normal when treatment is completed.
Loss of appetite	Loss of appetite.	A dietician or specialist will assist in boosting the appetite or other eating disorders
Nausea and vomiting	Nausea and vomiting typically begin within hours of treatment and last for up to a couple of days following treatment.	Doctors may prescribe anti-emetic drugs to prevent or reduce these side effects.
Resistance to infection	Gemcitabine may reduce the bone marrow’s ability to produce white blood cells and the reduction in white blood cells puts patients at risk for infection. Infection may begin about 1 week after treatment and the body’s resistance to infection will usually reach it lowest within 10 to 14 days after chemotherapy has ended.	Once chemotherapy has ended, the production of blood cells will begin to steadily increase and should return to normal within 21 to 28 days.If a patient experiences body temperature above 100.5^o F or the patient suddenly begins to feel bad, doctors will give the patient a blood test to check that the blood cells have recovered. If blood cells have not recovered, patients may have their chemotherapy delayed until the cells have recovered
Skin changes	An itchy rash may appear and the ankles may swell.	Doctors can prescribe medication for the rash. The swelling will disappear after treatment.
Tiredness and weakness	Patients may feel weak and very tired.	Patients should get plenty of rest.

Less Common Side Effects of Gemcitabine
Side Effect	Symptom	Solution
Breathlessness	Patients may experience temporary breathlessness.	Patients should consult their doctors of symptoms.
Diarrhea	Diarrhea may develop and become severe as result of the loss of fluid	May be controlled with medication and drinking more fluids.
Hair loss	A temporary condition that usually results in a thinning of the hair rather than a total loss of hair.	Re-growth will begin when treatment ends.
Sore mouth and ulcers	Infection may cause small ulcers to form in the mouth or the mouth may become sore.	Patients should drink plenty of fluids, clean their teeth regularly and gently. Doctors may prescribe special mouthwash or medication to clear or prevent infection.
Taste alterations	Patients may experience a temporary alteration in taste.	Diet as advised by a dietician or specialist.