New agents in gastrointestinal malignancies: Part 2: Gemcitabine in clinical practice

This is part two of the two-part series on new chemotherapy agents for gastrointestinal malignancies. The first article addressed the agent irinotecan hydrochloride (CAMPTOSAR Injection, Pharmacia & Upjohn Company, Kalamazoo, MI; also investigated under the name CPT-11) for use with metastatic colon cancer. This article discusses gemcitabine hydrochloride (GEMZAR for Injection, Eli Lilly and Company, Indianapolis, IN; also referred to as dFdC) for advanced pancreatic cancer. The article reviews the current clinical use, safety profile, and key patient management guidelines for the new and novel cytotoxic agent, gemcitabine, which was approved in 1996. This agent has demonstrated activity in pancreatic cancer, is generally well tolerated, and can safely be administered on an outpatient basis. Therapy-related side effects are manageable with appropriate monitoring and intervention, and reversible with dose modification or discontinuation. As clinical and investigational use of gemcitabine increases, the oncology nurse and other members of the health care team will need to anticipate potential treatment-associated toxicities and be knowledgeable in their early identification and management. As patient advocates, oncology nurses play a key role in treatment outcome and related quality of life through expert patient education, symptom recognition, and intervention according to individual patient tolerance.