GEMZAR...any tips from those who have had it?

[Sheila]

THere are so many sites about different chemos, but I have always found the best place to ask is right here, the women and men who have had 1st hand experience. Had my first Gemzar yesterday ...with Herceptin.....I will now be tethered to the IV pump weekly. I was shocked that I was given Decadron IV and Zofran IV before the Gemzar. I asked the nurse if it was to prevent allergic reactions, and she said no, it helps get rid of fluid buildup with Gemzar and also for nausea.....hoping I dont have to have the Decadron every time...that was the worst about Taxol! So this morning I have my bright red face, no nausea, just a little tired. My counts were not too good from the Halaven, so I will be anxious to see what the Gemzar brings....Halaven was the first drug to ever lower my counts in all these years. One nurse said hair loss is common, another said not usually......so give me the goods all you Gemzar users......hoping this will hold me for awhile!
Sending love and prayers to all who are struggling right now.....

[Rich66]

Decadron alternatives here:
http://her2support.org/vbulletin/showthread.php?p=214831#post214831
Some bits on Gemzar here:
http://her2support.org/vbulletin/showthread.php?t=41933&highlight=Gemcitabine

[ElaineM]

First of all here are some links about Decadron, including the positive and negative information about Decadron.
http://www.drugs.com/pro/decadron.html
http://www.ncbi.nlm.nih.gov/pubmed/688248
http://organizedwisdom.com/Dexamethasone
We need to remember that every drug has a positive side and a negative side since every drug, including those meant to prevent various side effects can have side effects of its own. We just have to weigh the pros and cons of everything we take.
Every time a medical professional wants to prescribe Decadron to me I refuse. Their usual excuse is to prevent nausea, so I tell them to prescribe a big bottle of anti nausea pills and forget the Decadron. I always get the pills, but I have never used any of them. It is nice to have "insurance" at home in case I need it. Ginger also works for nausea. Smile.
I also refuse Benedryl.
There are also alternatives for fluid build up and whatever else Benedryl and Decadron are supposed to do. All you have to do is ask your doctors what they are or do a search on the internet.
Good luck with the Gemzar. I really, really hope it works for you. Take care.

[Jackie07]

Sheila,

Below are the Gemzar users I gleaned from the 'Calling all Stage IV Sisters' thread and some abstracts I had found before (don't know where I had posted it - the second one is also on Rich's 2nd list). Hopefully these members will see this thread and respond soon.

Trish of Melbourne, Australia had used it briefly in July. 2008

radiant 2010 - went on Gemzar, Navelbine, Herceptin - Navelbine and Herceptin took liver mets down. lymph node slightly progressed.

SoCalGal 3/07 mets - lungs & sternum. Tykerb/Xeloda boo. Tykerb/Carbo/Gemzar boo.

CourtneyL Nov 09- April 10: Lung progression, add Gemzar to Herceptin, Zometa

Pam P 2/09 - gemzar/herceptin/zometa
March 11: Add Gemzar

Am J Clin Oncol. (http://javascript<b></b>:AL_get(this,%20'jour',%20'Am%20J%20Clin%20Oncol.' );) 2011 Jan 26. [Epub ahead of print]
Phase II Trial of Pegylated Liposomal Doxorubicin in Combination With Gemcitabine in Metastatic Breast Cancer Patients.
Jacquin JP (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Jacquin%20JP%22%5BAuthor%5D), Chargari C (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chargari%20C%22%5BAuthor%5D), Thorin J (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Thorin%20J%22%5BAuthor%5D), Mille D (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Mille%20D%22%5BAuthor%5D), Mélis A (http://www.ncbi.nlm.nih.gov/pubmed?term=%22M%C3%A9lis%20A%22%5BAuthor%5D), Orfeuvre H (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Orfeuvre%20H%22%5BAuthor%5D), Clavreul G (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Clavreul%20G%22%5BAuthor%5D), Chaigneau L (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chaigneau%20L%22%5BAuthor%5D), Nourissat A (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nourissat%20A%22%5BAuthor%5D), Dumanoir C (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Dumanoir%20C%22%5BAuthor%5D), Savary J (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Savary%20J%22%5BAuthor%5D), Merrouche Y (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Merrouche%20Y%22%5BAuthor%5D), Magné N (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Magn%C3%A9%20N%22%5BAuthor%5D).
Departments of*Medical Oncology ‡Public Health, Statistical Unit **Radiotherapy, Institut de Cancérologie de la Loire, St Priest en Jarez †Service of Oncology Radiotherapy, Hôpital d'Instruction des Armées du Val-de-Grâce ¶Department of Oncology Development, Laboratoire Schering Plough ♯Department of Oncology Development, Laboratoire Elli Lilly, Paris §Department of Medical Oncology, Centre Hospitalier de Bourg en Bresse, Bourg en Bresse ∥Department of Medical Oncology, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France.
Abstract
OBJECTIVE: To assess the efficacy and toxicity of pegylated liposomal doxorubicin combined with gemcitabine as first-line chemotherapy in metastatic breast cancer patients in a phase II trial.
PATIENTS AND METHODS: All breast cancer patients with HER2-negative status, hormone refractory tumor, assessable targets, with preserved performance status, and who had not received chemotherapy earlier as treatment for their metastatic disease were eligible. The patients received pegylated liposomal doxorubicin (30 mg/m, venous injection, day 1) concurrently with gemcitabine (1000 mg/m, venous injection, days 1 and 8), 1 cycle every 3 weeks.
RESULTS: Although 38 patients should have been included, this study was prematurely discontinued after recruiting 20 patients because of excessive toxicity: 75% of the patients experienced grade 3 or 4 treatment-related toxicity, including neutropenia, thrombopenia, hand-foot syndrome, and stomatitis, which significantly affected the quality of life. Cardiac toxicity was mild. With regard to efficacy, 50% of the patients (95% confidence interval, 26%-74%) experienced tumor response. The response rate was 40% in patients who had earlier received anthracyclines as adjuvant therapy. Median progression-free survival and median overall survival were 8.8 months and 19 months, respectively.
CONCLUSIONS: This combination was efficient, but not well tolerated. From these results, we could not recommend these doses for further assessment and lower doses should be preferred.

Med Oncol. (http://javascript<b></b>:AL_get(this,%20'jour',%20'Med%20Oncol.');) 2011 Jan 25. [Epub ahead of print]
Safety and efficacy of gemcitabine plus cisplatin combination in pretreated metastatic breast cancer patients.
Brito LG (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Brito%20LG%22%5BAuthor%5D), de Andrade JM (http://www.ncbi.nlm.nih.gov/pubmed?term=%22de%20Andrade%20JM%22%5BAuthor%5D), Lins-Almeida T (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lins-Almeida%20T%22%5BAuthor%5D), Zola FE (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Zola%20FE%22%5BAuthor%5D), Pinheiro MN (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Pinheiro%20MN%22%5BAuthor%5D), Marana HR (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Marana%20HR%22%5BAuthor%5D), Tiezzi DG (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Tiezzi%20DG%22%5BAuthor%5D), Peria FM (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Peria%20FM%22%5BAuthor%5D).
Department of Gynecology and Obstetrics, School of Medicine of Ribeirão Preto, São Paulo University, Avenida Bandeirantes, 3900, 8th Floor, Ribeirão Preto, SP, 14048-900, Brazil, lgobrito@gmail.com.
Abstract
Metastatic breast cancers (MBC) previously treated with anthracyclines (A) and taxanes (T) have a complicated management. Gemcitabine (G)-cisplatin (C) combinations have been used as synergistic salvage therapy in MBC and are considered as another option for patients with important symptoms and aggressive visceral disease. We analyzed the safety and efficacy of GC in AT-pretreated MBC, as well as overall survival (OS) and time to progression (TTP). Forty-nine subjects received IV G 750 mg/m(2) and C 30 mg/m(2), both d1 and d8 every 3 weeks. Response evaluation was performed every second cycle and in the end of treatment. GC protocol was the first-line palliative chemotherapy in half of the cases, and median number of cycles/patient were 4(2-12). Lung (75.5%) was the most frequent site of metastasis. Most of the patients related clinical improvement with chemotherapy with minimal/mild tolerable collateral effects in 85.7% of cases. Following 34 months, mean OS/TTP was 13.12/6.6 months. Objective-responded patients (40.3%) were statistically associated with the improvement in symptoms after CT (P < 0.01), and OS was directly correlated with chemotherapy response (P < 0.01). HER-2 overexpression was a prognostic factor with reduced OS (P = 0.01). GC protocol was effective and tolerable in objective-responded patients

Med Oncol. (http://javascript<b></b>:AL_get(this,%20'jour',%20'Med%20Oncol.');) 2010 Dec 31. [Epub ahead of print]
Gemcitabine and cisplatin salvage regimen in heavily pretreated metastatic breast cancer: a Brazilian experience.
de Lima Araújo LH (http://www.ncbi.nlm.nih.gov/pubmed?term=%22de%20Lima%20Ara%C3%BAjo%20LH%22%5BA uthor%5D), Moitinho MV (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Moitinho%20MV%22%5BAuthor%5D), Silva AM (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Silva%20AM%22%5BAuthor%5D), Gomes CA (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Gomes%20CA%22%5BAuthor%5D), Noronha Júnior H (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Noronha%20J%C3%BAnior%20H%22%5BAuth or%5D).
Hospital de Câncer III, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil, laraujo@inca.gov.br.
Abstract
Gemcitabine and cisplatin combination (Gem-Cis) is a commonly used regimen in metastatic breast cancer (MBC), with proven activity in phase II trials. It is mostly used as a salvage regimen for progressive disease refractory to anthracyclines and taxanes, and when liver dysfunction secondary to liver metastasis precludes these drugs. Retrospective review of medical charts was conducted for patients treated with Gem-Cis for MBC in a single institution in Brazil between January 2004 and July 2007. The purpose of this study was to evaluate the outcomes and toxicity of Gem-Cis in a broad indication, including patients with deteriorated performance status (PS) and liver dysfunction, which were excluded from clinical trials. Fifty-six patients were included. Median age was 52 years, 46.4% were hormone-receptor negative, 57.2% received 3 or more prior chemotherapy lines, and 34 had liver metastasis. The median overall survival (OS) was 7.6 months, the median progression-free survival was 3.3 months, and the response rate was 21.2%. In variable analysis, PS was significantly associated with OS, even after adjusting to other factors. Toxicities included grades 3 or 4 anemia in 19.3%, neutropenia in 21.1%, and thrombocytopenia in 12.3%. Gem-Cis was a relatively active combination in this population that typically carries a poor prognosis. The subgroup of patients with favorable PS experienced longer survival, even when liver metastasis and hepatic dysfunction were a concern. Toxicity was manageable and it was not correlated with PS or liver dysfunction.

[Adriana Mangus]

Hi Sheila,

I was on gemzar for awhile, at this time I can't recall having side effects. I no longer keep a diary of the meds I'm on. I will be seeing my oncologist in August--and will ask him, he has excellent memory!

In the meantime, please take it easy.

With Love,

Adriana

[Chelee]

Hi Shelia,
I've never been on Gemzar. However my Mother had advanced lung cancer and was on it for a while. She was 77 yrs old at the time and I was amazed--she handled it quite well. She had very few SE's from it. She did have mild nausea for a few days...but not bad. It did affect her appetite a little bit...but ate well regardless. Other then that it seemed to be a very tolerable chemo to do. She did have some fatigue a few days but it would pass. Her hair gradually started thinning out very slowly! We kept thinking maybe she wouldn't lose it all? She had to have WBR--had she not had that I think it might of just thinned out a bit? My Mother had other health issues so I was really worried about her starting chemo. Over all she just did great on Gemzar. So I don't think you of all ppl will have many problems? At least I hope not. I hope it kicks butt on your cancer and causes you little to no problems at all.

Chelee

[Jackie07]

Darlene Denise also has had Gemzar.

11/11/09 GEMZAR/HERCEPTIN FOR LIVER PROGRESSION

[Delaney]

Hi Sheila,
I've been on Gemzar since March 14 this year. I hate the red face but thankfully it goes after a day or so. The fluid retention is becoming a problem now, I was ok up to this week, so I must do a search and see what can be done. Gemzar is not affecting my hair, thats growing back after wbr. My appetite isnt great but I eat when I can. Hopefully someone else will have some good tips. Hope this chemo works well for you.

[Unregistered]

I never have Decadron with Abraxane even though it is standardly prescribed. I agree it is best avoided if possible. It turns me into an impulsive and agitated monster. My friend is on Gemzar for ovarian cancer and her hair has thinned but is still looking good with judicious styling. I hope you cope ok with the weekly schedule. It certainly is an impost on your precious time. All the best
Trish