From the Guidelines
For a patient with metastatic disease receiving cisplatin-gemcitabine, typically 4-6 cycles of treatment are recommended, with treatment response assessed after 2-3 cycles and continued for 2 more cycles in patients whose disease responds or remains stable 1. The treatment plan should be individualized based on the patient's performance status, comorbidities, and treatment response. Some key points to consider when administering cisplatin-gemcitabine include:
- Assessing treatment response after 2-3 cycles with appropriate imaging to determine if the regimen is effective
- Continuing treatment for 2 more cycles in patients whose disease responds or remains stable
- Discontinuing treatment earlier if there is disease progression or unacceptable toxicity
- Monitoring for common side effects such as myelosuppression, nephrotoxicity, neuropathy, nausea, and vomiting
- Providing supportive care with antiemetics, hydration, and dose adjustments based on renal function and hematologic parameters The specific number of cycles may vary depending on the type of cancer being treated, the patient's performance status, comorbidities, and treatment response, so individualization of the treatment plan is crucial, as noted in the most recent guidelines 1.
From the Research
Treatment Cycles for Metastatic Patients
The number of cycles for metastatic patients receiving cisplatin and gemcitabine can vary depending on the specific cancer type and patient response.
- For metastatic breast cancer, study 2 continued therapy up to a maximum of 8 cycles.
- For locally advanced or metastatic urothelial carcinoma, study 3 had a median number of cycles per patient of 3, ranging from 1 to 7 cycles.
- Study 4 found that no patients with cisplatin-ineligible metastatic urothelial carcinoma were able to receive the anticipated 6 cycles at full dose, but 14% completed 6 cycles with dose reductions.
- Study 5 compared paclitaxel/cisplatin/gemcitabine and gemcitabine/cisplatin in patients with locally advanced or metastatic urothelial cancer, but did not specify the exact number of cycles.
Dosage and Administration
- Study 3 administered gemcitabine 2500 mg/m(2) and cisplatin 35 mg/m(2) on day 1 and day 15 for an every 28-day schedule.
- Study 2 used gemcitabine (2,500 mg/m2) plus cisplatin 50 mg/m2, with study therapy continuing up to a maximum of 8 cycles.
- The optimal number of cycles for metastatic patients receiving cisplatin and gemcitabine is not clearly established and may depend on individual patient factors and response to treatment, as seen in studies 2, 3, 4, 5.