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Gemcitabine + methotrexate is a combination chemotherapy regimen consisting of two antimetabolite agents, gemcitabine and methotrexate. Gemcitabine is a deoxycytidine analog that inhibits DNA synthesis by incorporation into DNA and inhibition of ribonucleotide reductase, leading to masked chain termination and apoptosis in rapidly dividing cells. Methotrexate is a folic acid analog that inhibits dihydrofolate reductase (DHFR), blocking the synthesis of tetrahydrofolate required for purine and thymidylate synthesis, thereby inhibiting DNA replication and cell division. The combination has shown synergistic effects in preclinical models due to their complementary mechanisms—gemcitabine primarily targets S-phase cells while methotrexate disrupts nucleotide biosynthesis. This regimen has been studied as an alternative treatment option for malignant pleural mesothelioma (MPM) with evidence suggesting feasibility, acceptable toxicity, and clinical activity[1][2][6]. Novel formulations such as nanoparticle or macromolecular conjugates have also been explored to enhance delivery and reduce side effects[2][6].
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