Gemcitabine and capecitabine (GemCap) chemotherapy
This information is about a chemotherapy treatment that uses gemcitabine and capecitabine, known as GemCap. It's commonly used to treat cancer of the pancreas, but may be used to treat several different types of cancer.
The drugs that are used
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GemCap is named after the chemotherapy drugs used, which are:
How treatment is given
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GemCap chemotherapy is usually given to you as a day patient. Before you start treatment you'll need to have a blood test – either on the same day or a few days before. You'll also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. This may take a couple of hours.
The nurse will put a thin, flexible tube (cannula) into a vein in your arm or hand. You may find this uncomfortable or a little painful, but it shouldn't take long. Some people have their chemotherapy given through a thin, plastic tube that's inserted under the skin into a vein near the collarbone (central line), or through a vein in the crook of their arm (PICC line). Your doctor or nurse will explain this to you.
You'll be given some anti-sickness (anti-emetic) medicines. These are usually given by injection through the central line, PICC line or cannula, which is connected to a drip (infusion). Some anti-sickness medicines may be given as tablets.
The chemotherapy drugs are then given to you separately:
Gemcitabine is given as an infusion that lasts for about 30 minutes.
You'll then be given capecitabine tablets to take home.
Capecitabine is usually given as a combination of 500mg and 150mg peach-coloured tablets. You need to make sure you're taking the right dose as advised by your doctor, nurse or pharmacist.
The tablets should be swallowed whole with a glass of water. They should be taken within half an hour of finishing a meal, as capecitabine works best if it's broken down in the stomach with food. You should take them in the morning just after breakfast, and then again just after your evening meal. This is so that the doses are at least eight hours apart.
If you have trouble swallowing the capecitabine tablets, you can dissolve them in a 200ml glass of warm water. Stir the mixture with a spoon until the tablets are completely dissolved, and drink immediately. Wash the glass and spoon and keep them separate from your other crockery and cooking utensils.
If you're having your treatment as a day patient, you can go home after the gemcitabine and the cannula will be removed before you go. If you have a central or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You'll be shown how to look after the line.
You will be given a supply of anti-sickness tablets to take home with you. It's important to take these as directed even if you aren't feeling sick, as some anti-sickness drugs are much better at preventing sickness than at stopping it once it starts.
How often treatment is given
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Your doctor may use the word 'regimen' (eg the GemCap regimen) when talking about your chemotherapy. This means the whole plan or schedule of your particular treatment.
On the first day of your treatment (day one) you'll have an infusion of gemcitabine. You'll also start taking capecitabine tablets twice a day for three weeks (21 days). It's important to follow the instructions carefully and take the tablets as directed by your doctor.
One week later (day eight), you'll have a second infusion of gemcitabine. The gemcitabine is repeated again after another week (day 15).
When you've finished taking the capecitabine tablets (on day 21), you'll have a rest period, with no chemotherapy for one week. This completes a cycle of your chemotherapy. Each cycle lasts for 28 days (four weeks).
Following this rest period, four weeks after your first injection, you will start the next cycle of your treatment. Usually 4–8 cycles of treatment are given over a period of 3–4 months. This makes up a course of treatment.
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here won't affect everyone having GemCap chemotherapy.
We have outlined the most common side effects and some of the less common ones, so that you can be aware of them if they occur. However, we haven't included those that are rare and unlikely to affect you.
If you notice any effects that aren't listed here, please discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
GemCap can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia. This begins seven days after treatment and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising and bleeding
GemCap can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
GemCap can reduce the number of red blood cells, which carry oxygen around the body. A low blood red cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) or being sick (vomiting)
This is usually mild. If you do feel sick, it may begin a few hours after treatment and last for a few days. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting.
If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may work better for you. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
GemCap can cause diarrhoea. This can be severe, but can usually be controlled with medicines. It is important to drink plenty of fluids and you may be given medicine to take. Follow the instructions and take it immediately. If you have diarrhoea more than 4−6 times a day, or if you have it at night, contact your specialist for advice immediately. You may be advised to stop taking capecitabine.
However, once the diarrhoea has eased your doctor will tell you if you can restart the treatment, perhaps at a lower dose.
Abdominal pain and constipation
GemCap can cause pain in your tummy (abdomen) and constipation. Let your doctor know if you develop pain. It can usually be controlled with mild painkillers.
Constipation can usually be helped by drinking plenty of fluids, eating more fibre and doing some exercise. You may need to take medicine to help (laxatives). Your doctor can prescribe these or you can buy them at a pharmacy.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Treatment with GemCap may cause changes in the way your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems but your doctor will take regular blood samples to check your liver is working properly.
GemCap can cause a rash or dry skin, which may be itchy. Your doctor can prescribe medicine to help with this.
Soreness and redness of the palms of the hands and soles of the feet
This is known as palmar plantar, or hand-foot, syndrome. It is temporary and improves when the treatment finishes. If you get hand-foot syndrome, contact your specialist doctor or nurse for advice.
Your doctor may prescribe creams or a vitamin called pyridoxine (vitamin B6), which some people find helpful. It can also help to keep your hands and feet cool and to avoid tight-fitting clothing, such as socks, shoes and gloves.
During treatment with GemCap, and for several months afterwards, you will be more sensitive to the sun, and your skin may burn more easily than normal. You can still go out in the sun, but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat.
Occasionally, flu-like symptoms may occur. You may have headaches, a high temperature, aching joints and muscles. It is important to let your doctor know immediately if you get a high temperature.
This may cause swelling of the ankles or breathlessness. Let your doctor know if you notice either of these effects.
Feeling tired is a common side effect of chemotherapy especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Less common side effects
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This is rare, but your hair may thin or occasionally fall out completely. If this happens, it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. This is temporary and your hair will start to grow back once the treatment has finished.
Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Rarely, some people have tinnitus (ringing in the ears) and lose the ability to hear some high‑pitched sounds. This usually decreases when the treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
Rarely, gemcitabine can cause you to feel breathless for a short while. Contact your doctor if this happens.
Some people find that GemCap causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
Some people may feel dizzy or light headed. Tell your doctor if you have any of these side effects.
Increased production of tears
This may be caused by capecitabine and is temporary. You may also notice that your eyes become sore and inflamed (conjunctivitis). Let your doctor know so they can prescribe soothing eye drops if necessary.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Capecitabine interacts with the drugs phenytoin (Epanutin®), allopurinol (Zyloric®) and interferon (IntronA®, Roferon-A®). It may also affect the action of some medicines
given to thin the blood (anti-coagulants) such as warfarin. Let your doctor know if you are taking any of these.
You should also tell your doctor if you’re taking folic acid because it might increase the side effects of capecitabine.
Some other medicines, including those you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Gemcitabine may cause drowsiness. If you feel drowsy, it’s important not to drive or operate machinery.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having GemCap chemotherapy, as it may harm the developing baby. It’s important to use effective contraception while having this drug, and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Loss of periods in women
Due to the effect of chemotherapy on the ovaries, women may find that their periods become irregular and they may eventually stop.
In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
Things to remember about capecitabine tablets
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It’s important to take your tablets at the right times as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you are taking a course of chemotherapy tablets that should not be stopped or restarted without advice from your cancer specialist.
Keep the tablets in the original packaging and store them at room temperature away from heat and direct sunlight.
Keep the tablets in a safe place, out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
If you are sick just after taking the tablets, tell your doctor as you may need to take another dose. Don't take another tablet without telling your doctor first.
If you forget to take a tablet, don't take a double dose. Let your doctor know and keep to your regular dose schedule.
This section is based upon our GemCap chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 36th edition. 2009. Pharmaceutical Press.
British National Formulary. 58th edition. 2009. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). Accessed October 2011.
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.