Gemcitabine Interferes with Mesothelioma Tumor Cell Division

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Gemcitabine and Cisplatin May Improve Outcome of Surgery for Mesothelioma Patients, Study Suggests

October 1, 2004 — Treating mesothelioma patients with gemcitabine plus a standard platinum–based chemotherapy drug, cisplatin, prior to surgery may improve their survival rates, a recent report suggests (J Clin Oncol. 2004 Sep 1; 22(17): 3451–7). Commonly known under the brand name Gemzar^®, gemcitabine slows the growth of cancer cells by interfering with cell division and DNA synthesis. The combination of Gemzar^® plus cisplatin has been approved to treat inoperable, advanced non–small cell lung cancer.

Nineteen patients with pleural mesothelioma took part in the chemotherapy/surgery study. Pleural mesothelioma is a form of cancer that attacks the membranes surrounding the lungs and chest. Based on the prognostic score system advanced by the European Organization for Research and Treatment of Cancer, two patients had a good prognosis, and 17 had a poor prognosis. All 19 patients received three cycles of cisplatin and Gemzar^®. The response rate to chemotherapy was 32%.

Sixteen out of 19 patients then underwent an operation called an extrapleural pneumonectomy. In an extrapleural pneumonectomy, the surgeon removes portions of the lung, the lining of the lung, the lining of the heart, and the diaphragm. The goal of the operation is to remove cancer cells and slow down the progress of mesothelioma tumors.

Thirteen mesothelioma patients received postoperative radiotherapy after chemotherapy and surgery, and three did not. The median survival time for all 16 patients in the study was 23 months. Two patients remained alive and free of disease at 41 and 38 months after the start of therapy.

Some experts put the average survival time for mesothelioma patients who have undergone an extrapleural pneumonectomy without gemcitabine/cisplatin at 19–23 months. The study researchers suggest that chemotherapy, extrapleural pneumonectomy and post–operative radiation therapy may prove useful in treating patients with advanced mesothelioma. However, randomized clinical trials and further studies are necessary to provide further knowledge about this particular combination of chemotherapy, surgery, and radiotherapy.

Other Gemzar^® Studies

In one study at the University of Chicago, 60 pleural mesothelioma patients were treated with Gemzar^® alone in three clinical trials, and the positive response rates were 0%, 7%, and 31% (Semin Oncol. 2002 Feb; 29(1): 70–6). In another study, mesothelioma patients treated with Gemzar^® plus cisplatin achieved positive responses of 48%. Patients did not undergo surgery in either of these studies.

Eli Lilly, the manufacturer of both Gemzar^® and ALIMTA^®, is currently conducting a clinical trial for pleural mesothelioma patients, who will be treated with a combination of both these drugs. ALIMTA^® works by blocking the enzymes necessary for cancer cells to synthesize thymidine and purine. The study will consider the safety and side effects of the Gemzar^®/ALIMTA^® combination as well as its effects on survival rates, tumor reduction, and quality of life. The Food and Drug Administration recently approved the combination of ALIMTA^® and cisplatin to treat advanced cases of pleural mesothelioma in which surgery is not an option (see FDA Approves Sales of Mesothelioma Drug ALIMTA^®).

For more details about chemotherapy and other mesothelioma treatment choices, see Treatment Options. For information about your legal rights concerning mesothelioma, please feel free to contact us at Brayton Purcell. We have been handling cases involving mesothelioma and asbestos exposure for over 20 years and can provide support, information, and excellent advocacy.

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