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Gemcitabine is a chemotherapy drug that we’ve been using for quite some time, because it’s so effective. For the same reason, it’s used in multiple different cancer types. One important thing to know about gemcitabine is the clearance of the drug is up to 30% reduced in women and elderly populations. For that reason, it’s important to kind of be aware of the symptoms and side effects, as those demographics and some types may experience a greater severity of the symptoms. The biggest dose limiting factor for gemcitabine is what we call myelosuppression. Basically that means your bone marrow, when we say myelo, has trouble making the things that it’s supposed to make, the platelets that help you clot, the white blood cells, that help you fight infection, as well as the red blood cells that carry oxygen. So you’ll always be getting labs during the duration of your treatment to make sure that that effect on the marrow is not too pronounced. Sometimes you may have to take a week off or even require some transfusional support with packed red blood cells to make up for this myelosuppression.
Some other issues that are pretty rare, but are important to recognize are what’s called pneumonitis. And that’s basically inflammation of a part of your lung that can make you profoundly short of breath and hard to get your air. You get short of breath doing activities that you don’t usually do. Again, this is a pretty uncommon side effect, but if you experience that, it’s definitely something that you want to let your doctor know. Very rarely, it can also cause something called hemolytic uremic syndrome. And what this is is basically, your red blood cells in circulation just start getting torn up. You can see this simply by anemia, but we do what’s called a hemolysis workup, which basically means a few labs that we look at to say, “Is this something that’s tearing up our cells?” The things that get elevated to suggest that are what’s called LDH, indirect bilirubin, and a high reticulocyte count. That means the bone marrow is really pushing out these red blood cells to try and accommodate for this syndrome.
