From: "Dr. D. Kossove" <doctordee@telkomsa.net>
To: "Neil and Bev Sandow" <neil@q3.com>; "lmS List"
Subject: Gemzar Infusion Time
Date: Friday, January 16, 2004 12:32 PM

Gemzar is converted to the active metabolite at a slow rate.
Giving gemzar slowly over 90 minutes allows MORE of the gemzar given to be converted to the active metabolite.

Giving gemaar over 30 minutes, does not result in the same amount of gemzar being converted to active gemzar.  Because the reaction is slow, more gemzar is excreted while waiting to be converted.

A slow infusion results in gemzar being distributed widely in tissues.  A fast infusion does not result in high tissue levels.

The reason the slower infusion can be more toxic is because there is more active metabolite being formed.

IF that happens, the infusion time is still kept long, but the total dose of gemzar is decreased.

The 90 minute gemzar dose is more effective than slower doses, and is routinely used in LMS, so far as I know.

People who have had previous radiation may have worse reactions to gemzar, because it is a radiosensitizer.   Lung reactions are also more common in people who have had previous mediastinal or other thoracic radiation.

doreen
Together we are more, and more effective, than we are separately.

All correspondence is my personal opinion.  I am not an oncologist.  I am not practicing medicine online.  Provision of information is for investigation and discussion with your doctors.


Date:    Thu, 15 Jan 2004 23:53:12 -0800
From:    Neil Sandow <neil@Q3.COM>
Subject: Gemzar Infusion Time

Candace Widmer wrote:
>Greater than 90 minutes increases toxicity--to tumors and other tissues, I
>assume.   Faster rates
>of infusion are less toxic.


The manufacturer's instructions are to limit infusion to 60 minutes to
avoid increased toxicity.

Having said that I will comment that Bev's first infusion of Gemzar lasted
3 hours as a result of the nurse's error and I didn't know any better at
that time. Bev didn't seem to tolerate that first infusion any less well
than subsequent shorter infusions.

Repeated long infusions may indeed be unacceptably toxic. The response will
be very variable from one individual to another - remember that some
listmembers had very severe allergic reactions to the Gem/Tax combo
resulting in hospitalization. For others, like Bev, it was relatively easy.
I guess this is a concern that you'll have to discuss with your medical
oncologist.

Cordially, Neil Sandow (Bev's husband), Santa Cruz, CA

Beverly: 74, Dx'd uterine LMS following TAH/BSO 09/00. R lung RFAs (08/01 &
01/02) for 2 lung mets ultimately failed. Successful lobectomy and
bronchial sleeve resection of recurrence 05/02. Brain met found 10/04/02
and resected 10/14/02. All subsequent quarterly brain MRI's clear. PET scan
02/03 found 12 cm intensely hypermetabolic new met near L kidney. After 5
cycles of Gemzar / Taxotere tumor no longer visible on 07/07/03 PET scan
and confirmed necrotic on 07/28/03 CT scan following final 6th cycle of
chemo. Still NED, and necrotic tumor still shrinking, on 10/03 PET & CT. So
far so good. Next quarterly PET & CT scans scheduled for 01/04.
 