Gemcitabine: A pharmacologic and clinical overview

There have been exciting new developments in anticancer therapy over the past few years. One such therapy uses gemcitabine (GemzarR), an antimetabolite approved in 1996 by the Food and Drug Administration (FDA) for first-line treatment of locally advanced (nonresectable stage II or stage III) or metastatic (stage IV) adenocarcinoma of the pancreas. This novel nucleoside analog resembles the naturally occurring pyrimidine nucleoside deoxycytidine, but it has a unique mechanism of action. Clinical studies with gemcitabine have demonstrated anticancer activity in pancreatic cancer; non-small-cell lung cancer; breast, bladder, and ovarian cancers; and small-cell lung cancer. Clinical trials in patients with cancer of the pancreas used a novel study end point called clinical benefit response (CBR) to measure gemcitabine's effect on disease-related symptoms. The CBR is a composite assessment of performance status, pain, and weight gain. Studies show that gemcitabine has a relatively mild safety profile, with myelosuppression as the major dose-limiting toxicity. The aim of this review is to provide the oncology nurse with an overview of gemcitabine's pharmacology, innovative clinical trial end points, and clinical performance, as well as the nursing care required for the patient receiving this drug.