Gemcitabine for Adjuvant Therapy of Breast Cancer

Occasionally one encounters the situation of a breast cancer patient who received four cycles on Adriamycin and Cytoxan as adjuvant therapy after her surgery, but when the second part of the treatment begins, and she received Taxol or Taxotere, she has a reaction and cannot tolerate it. Some physicians than give four cycles of gemcitabine instead of a taxane. Unfortunately, this practice has not been formally studied.  Unlike for pancreatic cancer, there is not much literature regarding the use of gemcitabine for adjuvant therapy of breast cancer. One exception is the tANGo trial. The tAnGo trial was a randomized, open-label, multicenter phase III trial examining adjuvant treatment with epirubicin (Ellence)/cyclophosphamide (Cytoxan, Neosar) for four cycles followed by paclitaxel alone or combined with gemcitabine (Gemzar) for four cycles in patients with early-stage breast cancer. Gemcitabine has been included as a partner for paclitaxel in the tAnGo trial based on high response rates, including high complete response rates, observed in phase II trials of the combination in more advanced disease and based on the tolerability and safety of the combination compared with those of other taxane-containing two-drug combinations. It was not clear how much gemcitabine added to other drugs.

At this time gemcitabine is not well supported, alone or in combination for adjuvant therapy of breast cancer.

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