II. Indications
- FDA Approved
- Pancreatic Adenocarcinoma
- Non-Small Cell Lung Cancer
- Metastatic Breast Cancer
- Advanced Ovarian Cancer
- Off-Label Use: Advanced Cancers, Recurrent, Metastatic or Persistent
- Bladder Cancer
- Cervical Cancer
- Ewing Sarcoma
- Hepatobiliary Cancer
- Lymphoma (Hodgkin Lymphoma, Non-Hodgkin Lymphoma)
- Nasopharyngeal Cancer
- Osteosarcoma
- Renal Cell Carcinoma
- Small Cell Lung Cancer
- Soft Tissue Sarcoma
- Testicular Cancer (germ cell tumors)
- Thymic Cancer
- Uterine Sarcoma
III. Mechanism
- See Antimetabolite Chemotherapy
- Broad Spectrum, antineoplastic antimetabolite
- PyrimidineNucleoside analog of deoxycytidine
- Gemcitabine is a prodrug, metabolized to active metabolites by deoxycytidine kinase on infusion
- dFdCDP (difluorodeoxycytidine diphosphate)
- Inhibits ribonucleotide reductase
- Decreases the Nucleotide source for DNA synthesis, and potentiates dFdCTP uptake by DNA
- dFdCTP (difluorodeoxycytidine triphosphate)
- Competes with dCTP (deoxycytidine triphosphate)
- Incorporated into DNA, blocking DNA Polymerase and DNA Replication
- dFdCDP (difluorodeoxycytidine diphosphate)
IV. Medications
- Gemcitabine IV Solution in 200, 1000 and 2000 mg vials
V. Dosing
- See other references for disease specific dosing protocols
VI. Pharmacokinetics
- Hepatic and peripheral blood deamination to inactive metabolite (difluorouridine)
VII. Adverse Effects
- Alopecia
- Fever
- Hematuria or Proteinuria
- Hepatotoxicity
- Myelosuppression
- Rash
- Other uncommon, but serious adverse effects
VIII. Safety
- Avoid in Lactation
- Avoid in pregnancy (all trimesters)
- Use reliable Contraception
- Men should also not father children while taking Decitabine, and for 2 months after
- Monitoring
IX. Resources
- Gemcitabine Injection Solution (DailyMed)
X. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia