Gemcitabine(Drug information on 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, noncross-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(Drug information on 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.
Gabriel N. Hortobagyi, MD, FACP