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μ ¬μνλΉ(Gemcitabine)μ νμ’ μμ λ‘ μ¬μ©λλ **ν©μ± νΌλ¦¬λ―Έλ λ΄ν΄λ μ€μλ μ μ¬μ²΄**μ λλ€. - **μμνμ μ©λ**: νμ¬ μμ λ°μ΄ν°κ° μ νμ μ΄λ©° μνμ μΉλ£λ‘ κ°μ£Όλ©λλ€. μ μ λΆκ°λ₯ν μ’ μμ λν **λ°©μ¬μ λ―Όκ°μ **λ‘μ λλ λ³μ© ννμλ²(μ: 카보νλΌν΄κ³Ό λ³μ©)μ μΌλΆλ‘ μ μ¬λ ₯μ 보μ¬μ€λλ€. - **μΈμ²΄ μ©λ**: μ·μ₯μ, μμΈν¬ νμ, λ°©κ΄μ, μ°μ‘°μ§ μμ’ λ° λ¦Όνμ’ μΉλ£μ ν¨λ₯μ΄ μμ΅λλ€. > **μμ ν**: λμ λΉμ©κ³Ό μ¬κ°ν 골μ μ΅μ κ°λ₯μ± λλ¬Έμ μμνμμμ μ¬μ©μ μΌλ°μ μΌλ‘ μ λ¬Έ μ’ μν μ§λ£λ‘ μ νλ©λλ€.
μμ© κΈ°μ : Gemcitabine is a **cell-cycle phase-specific** antimetabolite that acts primarily during the **S phase** (DNA synthesis) and blocks progression through the G1/S-phase boundary. - It is transported intracellularly and phosphorylated to **dFdCMP**, then to active diphosphate (**dFdCDP**) and triphosphate (**dFdCTP**) metabolites. - **dFdCDP** inhibits **ribonucleotide reductase**, depleting the cellular pool of deoxynucleotides required for DNA synthesis. - **dFdCTP** competes with endogenous deoxycytidine triphosphate (**dCTP**) for incorporation into the elongating DNA strand. Once incorporated, it causes **DNA chain termination** and subsequent apoptosis.
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- Carcinomas (in combination with carboplatin) Β· 2 mg/kg IV over 20-30 minutes Β· IV Β· no more than once every 7 days Β· Doses have ranged widely from 45 mg/m2-800 mg/m2 depending on the study.
- Exocrine pancreatic carcinoma (Low dose) Β· 20-25 mg/m2 or 2 mg/kg Β· IV Β· every 7 days Β· Administer as a 20 minute IV infusion.
- Carcinomas (in combination with carboplatin) Β· 2 mg/kg IV over 20-30 minutes Β· IV Β· no more than once every 7 days Β· Doses have ranged widely from 45 mg/m2-800 mg/m2 depending on the study.
- Bladder urothelial carcinoma, lymphoma, and various carcinomas (High dose) Β· 800-900 mg/m2 Β· IV Β· every 7-14 days Β· for 4 doses Β· Administer over 20-60 minutes.
- Bladder urothelial carcinoma, lymphoma, and various carcinomas (Low dose) Β· 25-50 mg/m2 Β· IV Β· once or twice a week Β· Administer over 20-60 minutes as per protocols.
- Carcinomas (Combination therapy) Β· 2 mg/kg Β· IV Β· every 7 days Β· Administer over 20-30 minutes (in 0.9% NaCl) combined with carboplatin.
- Advanced solid tumors Β· Escalating doses per protocol Β· IV Β· single administration or per protocol Β· Phase 1 dose-escalation trial.
μ©λμ λ©΄ν μμ μ λ¬Έκ°λ₯Ό μν μμ μ°Έκ³ μλ£μ λλ€. νμ μ΅μ λΌλ²¨κ³Ό κ°λ³ νμμ λν΄ νμΈνμμμ€.
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- Hypersensitivity to gemcitabine
- Known hypersensitivity to gemcitabine
- Pre-existing bone marrow suppression
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- Myelosuppression (neutropenia and thrombocytopenia; nadir at 3-7 days)
- Mild to moderate gastrointestinal toxicity
- Retinal hemorrhage
- Myelosuppression (neutropenia, thrombocytopenia, anemia)
- Gastrointestinal toxicity (vomiting, diarrhea, anorexia)
- Retinal haemorrhage
- Treatment-related mortality (due to severe complications)
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- Other myelosuppressive agents Β· Additive toxic effects (myelosuppression, GI toxicity)
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- CBC before each treatment
- Fundic exam weekly while on therapy
- Baseline renal and hepatic function prior to therapy, and periodically thereafter
- Complete Blood Count (CBC) prior to each dose (monitor for myelosuppression)
- Hepatic function panel
- Renal function panel
- Gastrointestinal signs (vomiting, diarrhea, anorexia)
- Ophthalmic exam (monitor for retinal haemorrhage)
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There is no known antidote to gemcitabine in an overdose situation. Severe myelosuppression should be expected. Treatment is supportive.
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