Gemcitabine in Non-Small Cell Lung Cancer (NSCLC): The Evidence of its Therapeutic Value in Molecular Age

Lung cancer contributes to 31% of male and 26% of female cancer-related deaths and is the largest cause of cancer-related mortality in both men and women. Evaluation of new treatment strategies is ongoing to identify more effective treatments to overcome this dismal prognosis. Numerous studies and meta-analyses have proved the superiority of cisplatin-based third generation chemotherapy in NSCLC first line treatment but no gold standard exists. Two-drug third-generation chemotherapy provides a suitable alternative for patients with contraindications to platinum. Gemcitabine is a third generation agent successfully tested in non small lung cancer, either alone or in platinum and non platinum combination, and has become a drug of choice due to its advantageous toxicity profile. It has also been successfully combined with premetrexed, a new antitoxic agent, as well as with the vascular endothelial growth factor (VEGF) inhibitor bevacizumab, for adenocarcinoma histological nonsmall cell subtype. On the other hand, the identification of potential prognostic and predictive molecular markers in the latest years, not only for novel targeted tyrosine kinase inhibitors but also for gemcitabine and other agents, may enable customized therapies for specific patient populations, allowing improved efficacy and reduced toxicity and cost. This review aims to provide an update on gemcitabine and its therapeutic value in modern molecular sitting.