The role of gemcitabine in the treatment of other tumours

Gemcitabine (GEMZAR) is a novel nucleoside analogue with activity in a range of preclinical models both in vitro and in vivo. It is highly schedule dependent, with weekly x3 every 4 weeks being the recommended schedule for phase II/III studies. Early phase II trials identified activity against non-small-cell lung cancer and pancreatic cancers, tumour types for which gemcitabine has a licence for treatment in many countries. However, the preclinical models indicated that gemcitabine may be active against many other human solid tumours. In phase II studies, activity has been identified against breast cancer, both as a single agent and in combination. In bladder cancer, impressive single-agent activity of gemcitabine has also been seen, as well as in combination with cisplatin, initially in MVAC and platinum failures but more recently as first-line therapy both as a single agent and combined with cisplatin. Anti-tumour activity has also been seen in patients with ovarian cancer, head and neck cancer, small-cell lung cancer and cervical cancer, with minimal activity in renal carcinoma, prostate and colon cancer. In view of the excellent side-effect profile and the potential for gemcitabine to inhibit DNA repair after exposure to DNA-damaging agents, further developments of gemcitabine will include its use in combination chemotherapy and combined modality schedules.