Gemcitabine

Gemcitabine is one of the older chemotherapy drugs that goes by the trade name Gemzar. Researchers are excited about the possibility of prolonging the lives of mesothelioma victims with the use of Gemcitabine in combination with other chemotherapy drugs and surgery. Gemcitabine works by mimicking normal substances within the cancer cell. When the cancer cell takes in the Gemcitabine and incorporates it in its cell metabolism, the cancer cell is unable to divide. The result is the death of the cancer cells.

Gemcitabine in combination with the chemotherapy drug Carboplatin is commonly used to treat various forms of lung cancer. More recently, a study in the Journal of American Medical Association reported that Gemcitabine showed benefit to patients with pancreatic cancer. Gemcitabine is also used to treat bladder and ovarian cancers.

Use in Clinical Trials Involving Mesothelioma

Gemcitabine is currently being used in three mesothelioma clinical trials. In a Phase II clinical trial being conducted by Columbia University, Gemcitabine is being used in combination with Oxaliplatin (trade name Eloxatin) to treat patients with pleural mesothelioma and peritoneal mesothelioma. In another clinical trial being conducted by Dr. David Sugarbaker at the Brigham and Women’s Hospital in Boston, Massachusetts, heated Cisplatin and Gemcitabine are being administered directly into the chest cavity following surgical removal of the pleural mesothelioma tumor. There is also a clinical trial underway in Italy testing the combination of Gemcitabine and Gleevec.

Clinical Trial at Brigham and Women’s Hospital, Boston

Doctors and researchers are finding that multimodality treatments are offering improved survival rates for patients with pleural mesothelioma. One such treatment is offered by Dr. David Sugarbaker at the Brigham and Women’s Hospital in Boston. Dr. Sugarbaker is the Founder and Director of the International Mesothelioma Program where cytoreductive surgery is part of the care offered. Cytoreductive surgery means that a patient undergoes one of two types of surgery that removes as much of malignant tumor as possible. A pleurectomy or decortication removes the diseased lining of the lung, called the pleura. An extrapleural pneumonectomy removes the pleura and the lung. Following the surgery, heated chemotherapy drugs are used. Research has shown that when these chemotherapy drugs are administered directly into the chest their effectiveness is increased. Now doctors are working to determine which combination of chemotherapy drugs provides the best result. Gemcitabine and another chemotherapy drug, Cisplatin, are presently being tested in a clinical trial to establish the effectiveness of this combination.

Researchers have found that the combination of Cisplatin and Gemcitabine has been effective in tumors both in vitro and in vivo. Gemcitabine has been used to treat other abdominal malignancy so researchers are anxious to try this combination as part of the heated chemotherapy protocol after surgery in the case of pleural mesothelioma patients. This heated chemotherapy drug combination kills the tumor cells that remain at the surgical margins. The combination of Cispatin and Gemcitabine enter the cells by diffusion which maximizes the toxic effect of the drugs.

Brigham and Women’s Hospital is conducting the first clinical trial to test this drug combination. The trial will attempt to determine the maximum allowable doses of the two drugs and their combined effectiveness. According to Tamara Tilleman, MD, PhD, the Director of Clinical Trials at the hospital, treatment will be tailored to each individual patient’s condition.

Clinical Trial in Italy

Dr. Giovanni Gaudino, a visiting scholar at the Cancer Research Center in Hawaii, is conducting a clinical trial in Italy on mesothelioma patients using Gemicitabine in combination with a different drug, Imatanib Mesylate (trade name Gleevec). Dr. Gaudino reported that the combination of the two drugs was very effective in reducing the size of the tumors in laboratory mice. In a pilot study involving 21 patients with mesothelioma, Dr. Guardino found that thecombination of Gleevec and Gemcitabine indicated very promising results with six (6) patients with no progression of the cancer; one (1) patient with complete disappearance of the cancer; eight (8) with partial response; and six (6) with disease progression.

Due to the success of the Phase I study, Dr Gaudino’s research is moving to a Phase II clinical trial. This will involve a larger number of mesothelioma patients to continue to measure the effectiveness of this drug combination. According to Dr. Gauidino, “We are quite optimistic that at least this therapy can lead to a longer survival…which for mesothelioma patients has to be considered a good response.”