Taking gemcitabine shortly after an initial course of chemotherapy can keep mesothelioma at bay significantly longer, but often at a heavy cost, according to Dutch researchers.
A study published Jan. 27 in The Lancet: Respiratory Medicine reviewed results from mesothelioma patients who followed up their first round of chemotherapy with gemcitabine. While maintenance drugs are not commonly used after an initial round of chemotherapy due to their toxicity and general ineffectiveness, the team wanted to test the usefulness of this particular chemotherapy drug, which is commonly marketed as Gemzar.
Researchers from the Netherlands Cancer Institute in Amsterdam and affiliated practitioners conducted a randomized trial in 18 hospitals, comparing progression-free survival in 130 patients, half of whom received supportive care and gemcitabine as maintenance therapy. The other half received only supportive care.
Three More Months
After a series of follow-up visits with the patients, the team concluded that gemcitabine typically brought patients an additional three months before the disease started to progress. It took those mesothelioma patients an average of six months to show signs of progression, versus supportive care-only patients, who showed signs in half the time. These results were confirmed by masked independent central review.
All patients were alive and ambulatory in their follow-ups after this switch-maintenance therapy, in which the initial treatment was switched to gemcitabine.
“Switch-maintenance gemcitabine, after first-line chemotherapy, significantly prolonged progression-free survival compared with best supportive care alone.” the researchers wrote at the conclusion of the five-year-long study.
Serious Consequences
However, this method frequently took a hefty toll on patients’ health.
Fifty-two percent of the gemcitabine patients experienced serious adverse events. On the 5-point adverse events scale, with Grade 1 being mild and Grade 5 proving fatal, more than half of all gemcitabine patients reported either severe adverse events (Grade 3) or life-threatening ones (Grade 4). One of the patients died following a treatment-related infection, the researchers reported.
By contrast, only 16 percent of the patients in the supportive care group experienced equally severe adverse events. The most common adverse events reported in the gemcitabine group were anemia, fatigue or asthenia, infection, neutropenia, and pain. For the supportive care-only patients, the most common adverse events were cough or dyspnea, infection, and pain.
