Gemcitabine (Gemzar) has emerged from its initial clinical evaluation in patients with metastatic breast cancer as an effective antitumor agent. Its usual schedule of administration is weekly, and it is a very well-tolerated regimen. In combination with anthracyclines, the activity matches that of other commonly used multidrug regimens, including CMF (cyclophosphamide [Cytoxan, Neosar]/methotrexate/fluorouracil) or FAC (fluorouracil/doxorubicin [Adriamycin]/cyclophosphamide). When the taxanes became the most effective agents against breast cancer, two-drug and three-drug combinations with gemcitabine were initiated. This development was stimulated by the need to discover effective, non–cross-resistant regimens for patients previously exposed to anthracyclines and classical alkylating agents.
Laufman and collaborators (abstract #336) have taken a full single-agent dose of docetaxel (Taxotere) and combined it with gemcitabine at 67% of the usual single-agent dose. No dose escalation was possible, and some patients required deescalation. The combination was well tolerated and effective, achieving objective responses in more than two-thirds of patients treated. Considering that all but one of the evaluable patients were previously treated with an anthracycline, this regimen appears quite active. Docetaxel/gemcitabine appears, then, to be a second well-tolerated and markedly effective combination for patients with metastatic breast cancer previously treated with an anthracycline-containing regimen.