
A chemotherapy cocktail regimen of Gemcitabine + taxotere [docetaxel] can give a 50 to 60% response in Uterine LMS [1], and be active in sarcomas generally. Yet can trigger a serious pulmonary condition and a fatal cardiac condition. [2]   Potent drugs are potent drugs.

The most effective schedule for infusion is yet to be proved.  Lesser amounts of gemcitabine might be more effective [and are more toxic] if infused at the rate determining step over a longer period of time.  Currently, the infusion rate for gemcitabine use in LMS is set at 90 minutes. 

Gemcitabine has been shown to be a potent radiosensitizer, and this property has been used to downsize LMS tumors in chemoradiation regimens.  However, gemcitabine lung reactions occur more frequently in patients who have had prior radiation to the mediastinum.[2]


<b>[1] A recent clinical trial of the combination of gemcitabine and docetaxel reported favorable results in patients with unresectable, predominantly uterine leiomyosarcoma (LMS). The objective of this report is to describe additional experience with this combination in a variety of histologic subtypes of sarcoma. 

Responses occurred in 6/10 LMS from various primary sites,</b> and in total there were 5 complete responses and 8 partial responses for an overall response rate of 54%. 

2002 CTOS Annual Meeting Posters
Medical Oncology Abstract ID: 80
GEMCITABINE AND DOCETAXEL IN SARCOMA
Kirsten M. Leu1, Mark Zalupski1, Vernon Sondak1, Krisinda Snyder1, Laurence H. Baker1 
University of Michigan Comprehensive Cancer Center, MI, United States 
kmleu@umich.edu

<b>[2]Gemcitabine cardiac and pulmonary toxicity ran 10% in this study and prior mediastinal radiation increased the pulmonary complications to 2 out of three.</b>

Severe Nonhematologic Toxicity After Treatment with Gemcitabine 
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"We report a series of 4 out 56 patients (7.1%) treated with gemcitabine who developed an unexplained noncardiopulmonary distress syndrome most likely related to gemcitabine. One further patient developed ventricular arrhythmia immediately after gemcitabine exposure leading to cardiac arrest."
" In 5 patients... we assumed that gemcitabine is related to pulmonary or cardiac toxicity, respectively. In 3 patients reexposure resulted in identical toxicity. One patient did not receive further gemcitabine treatment due to life threatening primary event. In one patient pleural effusion occurred. Two patients had prior [recent] radiation to the mediastinum" 
" Life threatening pulmonary toxicity after gemcitabine treatment was more common than initially anticipated. Gemcitabine should be used with caution in patients who received prior radiation to the mediastinum"
