Epirubicin + Gemcitabine + Paclitaxel

The combination of epirubicin, gemcitabine, and paclitaxel (GET) is a chemotherapy regimen primarily used in the treatment of metastatic breast cancer. This combination has been studied in several clinical trials to evaluate its efficacy and safety profile. The GET regimen typically consists of gemcitabine 1,000 mg/m² administered on days 1 and 4, epirubicin 90 mg/m² on day 1, and paclitaxel 175 mg/m² on day 1, with cycles repeated every 21 days for up to eight courses[1][2]. This combination was developed based on the hypothesis that epirubicin/paclitaxel is well-suited for optimal dose delivery, and the addition of gemcitabine (which has good single-agent activity with a favorable toxicity profile) would increase the overall activity of the regimen[2]. In phase II trials, the GET combination demonstrated promising results with high response rates. One study reported an overall response rate of 89% with a 28% complete response rate[1]. Another phase II trial with 36 patients showed a 92% response rate with a 31% complete response rate[5]. When followed by high-dose consolidation chemotherapy, the response rates increased further to 97% with a 47% complete response rate[5]. The GET regimen has been compared with other chemotherapy combinations in phase III trials. One study compared GET with fluorouracil, epirubicin, and cyclophosphamide (FEC) as first-line therapy in patients with metastatic breast cancer. After a median follow-up of 20.4 months, the median time to progressive disease was similar between the two arms (9.1 months for GET vs. 9.0 months for FEC), and the overall response rate was 62.3% in the GET arm compared to 51.2% in the FEC arm, though this difference was not statistically significant[4]. Regarding toxicity, the GET regimen is generally well-tolerated, with myelosuppression being the most common adverse effect. Grade 4 neutropenia has been reported in 56% of patients[1]. In comparative studies, grade 3 and 4 toxicities, including neutropenia, thrombocytopenia, anemia, stomatitis, neurosensory toxicity, and allergic reactions, occurred significantly more often in the GET arm compared to the FEC arm[4]. Pharmacokinetic studies have shown that gemcitabine does not influence the interactions between epirubicin and paclitaxel, while gemcitabine kinetics remain unchanged in the combination[5]. The GET regimen has also been found to efficiently mobilize peripheral blood progenitor cells, making it a potential induction treatment before high-dose chemotherapy[5]. Based on these findings, the GET combination represents a potentially effective treatment option for patients with metastatic breast cancer, though its higher toxicity profile compared to some other regimens should be considered in treatment decisions.

Other names

GET regimen