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Gemcitabine Used as a Maintenance Therapy Could Help Mesothelioma Patients Live Longer

Published: February 5, 2021

Using maintenance therapy with gemcitabine alongside chemotherapy can help increase survival in patients compared to patients just receiving palliative care. Gemcitabine is an antimetabolite, which prevents cancer cells from dividing into new cancer cells. Chemotherapy is usually the first line treatment for mesothelioma, and if patients are able to receive surgery, it is used as well. Gemcitabine is being studied as a maintenance therapy, which helps the standard treatment stay effective over time. The study is showing that Gemcitabine could be an effective maintenance therapy and could help mesothelioma patients live longer lives.

Mesothelioma is a very aggressive cancer with no cure. Patients have very limited options for treatment, with the primary treatment being chemotherapy. Chemotherapy is not always effective for patients though, so new treatments need to be tested so a more effective therapy can be found. Studies show that chemotherapy extends the survival of mesothelioma patients by an average of four months. If patients also use maintenance therapy, the chemotherapy could be effective for a longer period of time and could extend the lives of mesothelioma patients.

The study conducted at the Netherlands Cancer Institute had 130 mesothelioma patients from a total of 18 different hospitals. All the patients were diagnosed between the years 2014 and 2019 and had unresectable mesothelioma, which means they could not receive surgery. All patients underwent four rounds of chemotherapy and had no mesothelioma progression. There were two groups in the study. One group was given the gemcitabine maintenance therapy while the other group just received supportive care. The maintenance therapy consisted of 1250 mg/m2 of gemcitabine on days 1 and 8 in cycles of 21 days. If the patient had a severe reaction or a serious illness appeared, the study was stopped. Patients also had the option to stop if they asked.

Both groups were followed for three years and the researchers found that the patients who received the gemcitabine maintenance therapy had a better survival. The treatment was effective, but it also had negative side effects. More than half of the patients receiving the gemcitabine had grade 3-4 adverse side effects compared to 16 percent of the supportive care patients having these types of events. Patients had anemia, low white blood cells, fatigue, pain, infection, and one of the gemcitabine patients died.

Problems aside, gemcitabine could help mesothelioma patients live longer. Other drugs have been tested as second line treatments for mesothelioma including more rounds of pemetrexed, taxane and gemcitabine, imatinib and gemcitabine, docetaxel, avelumab, and tremelimumab. These treatments have only extended survival by at most eight months.

Cormedine J de Gooijer, MD et al., “Switch-maintenance gemcitabine after first-line chemotherapy in patients with malignant mesothelioma (NVALT19): an investigator-initiated, randomised, open-label, phase 2 trial” The Lancet Respiratory Medicine (January 27, 2020). [Link]
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