Gemcitabine

Adults: For non-small cell lung cancer, when Gemcitabine is used on its own, the recommended dose is 1000 mg/m2 given as a 30-minute intravenous infusion. This is repeated once a week for three weeks, followed by a one-week rest period, and the four-week cycle is then repeated. The dose may be reduced from one cycle to the next, or within a cycle, depending on how much toxicity the patient experiences. When used in combination with Cisplatin, Gemcitabine has been studied using two dosing regimens: one on a three-week schedule and the other on a four-week schedule. The three-week schedule used Gemcitabine 1250 mg/m2 as a 30-minute intravenous infusion on days 1 and 8 of each 21-day cycle. The dose may be reduced from one cycle to the next, or within a cycle, depending on the toxicity experienced. The four-week schedule used Gemcitabine 1000 mg/m2 as a 30-minute intravenous infusion on days 1,8, and 15 of each 28-day cycle. Here too, the dose may be reduced with each cycle or within a cycle according to the patient's toxicity. For pancreatic cancer, the recommended dose of Gemcitabine is 1000 mg/m2 given as a 30-minute intravenous infusion. This is repeated once a week for up to 7 weeks, followed by a week of rest. Later cycles consist of an injection once a week for 3 consecutive weeks out of every 4 weeks. The dose may be reduced with each cycle or within a cycle depending on the toxicity the patient experiences. For bladder cancer, when Gemcitabine is used on its own, the recommended dose is 1250 mg/m2 given as a 30-minute intravenous infusion on days 1,8 and 15 of each 28-day cycle; this 4-week cycle is then repeated. The dose may be reduced with each cycle or within a cycle according to the toxicity experienced. When used in combination with Cisplatin, the recommended dose of Gemcitabine is 1000 mg/m2 given as a 30-minute infusion on days 1,8 and 15 of each 28-day cycle. Cisplatin is given at a recommended dose of 70 mg/m2 either on day 1 after Gemcitabine or on day 2 of each 28-day cycle, and this 4-week cycle is then repeated. The dose may be reduced with each cycle or within a cycle depending on the patient's toxicity. A clinical trial found more myelosuppression when Cisplatin was used at doses of 100 mg/m2. For breast cancer, Gemcitabine is recommended in combination with Paclitaxel. Paclitaxel (175 mg/m2) is given on Day 1 as an intravenous infusion over approximately 3 hours, followed by Gemcitabine (1250 mg/m2) as a 30-minute intravenous infusion on Days 1 and 8 of each 21-day cycle. The dose may be reduced with each cycle or within a cycle depending on the toxicity experienced. Before starting the Gemcitabine plus Paclitaxel combination, patients should have an absolute granulocyte count of at least 1,500 (x106/L). For ovarian cancer, Gemcitabine is recommended in combination with Carboplatin, with Gemcitabine 1000 mg/m2 given as a 30-minute intravenous infusion on days 1 and 8 of each 21-day cycle. After Gemcitabine, Carboplatin is given on day 1 at a dose consistent with a target AUC of 4.0 mg/mL/min. The dose may be reduced with each cycle or within a cycle depending on the toxicity the patient experiences.