Care During Chemotherapy and Beyond
Trade Name: Gemzar
Gemcitabine is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.
Gemcitabine is classified as an antimetabolite. (For more detail, see "How
Gemcitabine Works" below).
What Gemcitabine Is Used For:
- Pancreas cancer
- Non-small cell lung cancer
- Bladder cancer
- Soft-tissue sarcoma
- Metastatic breast cancer
- Ovarian cancer
Note: If a drug has been approved for one use, physicians sometimes elect
to use this same drug for other problems if they believe it might be helpful.
How Gemcitabine Is Given:
- Gemcitabine is given by infusion through a vein (intravenously, by IV).
- There is no pill form of Gemcitabine.
- The amount of Gemcitabine you will receive depends on many factors, including your
height and weight, your general health or other health problems, and the type of
cancer you have. Your doctor will determine your exact dosage and schedule.
Important things to remember about the side effects of Gemcitabine:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset, duration and severity.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the
effectiveness of the medication.
The following side effects are common (occurring in more than 30%) for patients
Nadir: Meaning low point,
nadir is the point in time between chemotherapy cycles in which you experience
low blood counts.
Onset: none noted
Nadir: 10-14 days
Recovery: day 21
These are less common side effects (occurring in 10-29%) for patients receiving
- Hair loss
- Mouth sores
- Difficulty sleeping
- Shortness of breath (see lung problems)
Not all side effects are listed above, some that are rare (occurring in less than
10% of patients) are not listed here. However, you should always inform your
health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
Contact your health care provider immediately, day or night, if you should
experience any of the following symptoms:
- Fever of 100.4ºF (38ºC) or higher, chills (possible signs of infection)
The following symptoms require medical attention, but are not emergency situations.
Contact your health care provider within 24 hours of noticing any of the following:
- Nausea that interferes with eating and is not relieved by medications prescribed
by your doctor.
- Vomiting (more than 4-5 episodes within a 24-hour period)
- Extreme fatigue (inability to perform self-care activities)
- Diarrhea (more than 4-6 episodes in a 24-hour period)
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools or urine
Always inform your health care provider if you experience any unusual symptoms.
- Before starting Gemcitabine treatment, make sure you tell your doctor about any
other medications you are taking (including prescription, over-the-counter, vitamins,
herbal remedies, etc.). Do not take aspirin or products containing aspirin
unless your doctor specifically permits this.
- Do not receive any kind of vaccination without your doctor's approval while taking
- Inform your health care professional if you are pregnant or may be pregnant prior
to starting this treatment. Pregnancy category D (Gemcitabine may be hazardous to
the fetus. Women who are pregnant or become pregnant must be advised of the
potential hazard to the fetus).
- For both men and women: Do not conceive a child (get pregnant) while taking Gemcitabine.
Barrier methods of contraception, such as condoms, are recommended. Discuss with
your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking Gemcitabine.
- For flu-like symptoms, keep warm with blankets and drink plenty of liquids.
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed
- You may be at risk of infection so try to avoid crowds or people with colds, and
report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times
a day with 1/2 to 1 teaspoon of baking soda and/or salt mixed with 8 ounces of water.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and
eat small, frequent meals.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
- You may experience drowsiness or dizziness; avoid driving or engaging in tasks that
require alertness until your response to Gemcitabine is known.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health
care team. They can prescribe medications and/or offer other suggestions that
are effective in managing such problems.
Monitoring and Testing:
You will be checked regularly by your doctor while you are taking Gemcitabine, to
monitor side effects and check your response to therapy. Periodic blood work
will be obtained to monitor your complete blood count (CBC) as well as the function
of other organs (such as your kidneys and liver) will also be ordered by your doctor.
How Gemcitabine Works:
Cancerous tumors are characterized by cell division, which is no longer controlled
as it is in normal tissue. "Normal" cells stop dividing when they come
into contact with like cells, a mechanism known as contact inhibition. Cancerous
cells lose this ability. Cancer cells no longer have the normal checks and
balances in place that control and limit cell division. The process of cell
division, whether normal or cancerous cells, is through the cell cycle. The
cell cycle goes from the resting phase, through active growing phases, and then
to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt
cell division. Usually, the drugs work by damaging the RNA or DNA that tells
the cell how to copy itself in division. If the cells are unable to divide,
they die. The faster the cells are dividing, the more likely it is that chemotherapy
will kill the cells, causing the tumor to shrink. They also induce cell suicide
(self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle
specific. Chemotherapy drugs that affect cells when they are at rest are called
cell-cycle non-specific. The scheduling of chemotherapy is set based on the
type of cells, rate at which they divide, and the time at which a given drug is
likely to be effective. This is why chemotherapy is typically given in cycles.
Unfortunately, chemotherapy does not know the difference between the cancerous cells
and the normal cells. Chemotherapy will kill all cells that are rapidly dividing.
The "normal" cells will grow back and be healthy but in the meantime, side effects
occur. The "normal" cells most commonly affected by chemotherapy are the blood
cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting
in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different
drugs may affect different parts of the body.
Gemcitabine belongs to the family of drugs called antimetabolites. Antimetabolites
are very similar to normal substances within the cell. When the cells incorporate
these substances into the cellular metabolism, they are unable to divide.
Antimetabolites are cell-cycle specific. They attack cells at very specific
phases in the cycle. Antimetabolites are classified according to the substances
with which they interfere:
- Folic acid antagonist: Methotrexate
- Pyrimidine antagonist: 5-Fluorouracil, Foxuridine, Cytarabine, Capecitabine,
- Purine antagonist: 6-Mercaptopurine and 6-Thioguanine
- Adenosine deaminase inhibitor: Cladribine, Fludarabine and Pentostatin
Note: We strongly encourage you to talk with your health care professional about
your specific medical condition and treatments. The information contained in this
website is meant to be helpful and educational, but is not a substitute for medical
Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org