This information is about a chemotherapy treatment for advanced breast cancer called GemTaxol. It may also be used for other types of cancer.
The drugs that are used
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GemTaxol is named after the chemotherapy drugs used, which are:
How treatment is given
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GemTaxol chemotherapy is usually given to you as a day patient. Before you start your treatment, you'll need to have a blood test on the same day or a few days beforehand. You'll also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood tests 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 is inserted under the skin and 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.
Once your chemotherapy treatment is ready you'll be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula, which is connected to a drip (infusion). Some anti-sickness drugs can be taken as tablets.
You'll also be given a ‘pre-med’ to help prevent an allergic reaction to the paclitaxel. This involves injecting the drip with a steroid drug called dexamethasone, or you may be given steroid tablets to take instead.
You'll be given a drug to protect your stomach from the irritation that dexamethasone can cause; often a drug called ranitidine (Zantac®). This will be given to you either as tablets or as an injection into your drip.
The chemotherapy drugs are then given to you separately:
Gemcitabine (a colourless fluid) is given as an infusion that lasts about 30 minutes.
Paclitaxel (a colourless fluid) is also given as an infusion, which takes three hours.
If you're having your treatment as a day patient you can then go home after it's finished. 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'll be given a supply of anti-sickness drugs to take home with you. You should take them regularly if you have been told to do so, even if you aren't feeling sick. This is because some medicines are much more effective at preventing sickness than stopping it once it starts.
How often treatment is given
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Your doctor may use the word 'regimen' (eg the GemTaxol regimen) when talking about your chemotherapy. This refers to the whole plan or schedule of your particular treatment.
On the first day of your treatment, you'll have both the gemcitabine and paclitaxel, as previously described. On the same day of the following week (day 8) you'll have a drip of gemcitabine only. You'll then have a rest period of two weeks. This completes a cycle of your chemotherapy. Each cycle lasts for 21 days (three weeks).
You'll start the next cycle of your treatment after the rest period, which will be three weeks after your first infusions. Usually 4–6 cycles of treatment are given over a period of 3–5 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 experience more. The side effects described here won't affect everyone having GemTaxol chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Gemcitabine and palitaxel can both reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia 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'll 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 the number of your blood cells (blood count) is still low.
Bruising or bleeding
GemTaxol 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 may need to have a platelet transfusion if your platelet count is low.
GemTaxol can reduce the number of red blood cells, which carry oxygen around the body. A low red blood 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)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
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 some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
This usually starts 2–3 weeks after the first dose of paclitaxel, although it may happen earlier. Hair usually falls out completely but it may just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary, and your hair will start to grow back once treatment the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before treatment. Your nurse can give you advice about coping with hair loss.
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 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.
Numbness or tingling in hands or feet
This is due to the effect of paclitaxel on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It's important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly, a few months after the treatment has finished. Sometimes symptoms can persist; talk to your doctor if this happens.
Aching or pain in joints and muscles
You may have this a few days after you are given Paclitaxel. It doesn't usually last long and your doctor can prescribe painkillers or anti-inflammatory drugs to help.
Let your doctor know if you develop any pain in your tummy (abdomen) pain. It can usually be controlled with mild painkillers.
Gemcitabine can cause a rash or dry skin, which may be itchy. Your doctor can prescribe medicine to help with this.
Less common side effects
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Some people can have an allergic reaction to paclitaxel while it’s being given. Signs of this can include skin rashes and itching, a high temperature (fever), shivering, dizziness, a headache and breathlessness.
Usually you'll be given steroid tablets to take at home the day before treatment to reduce the chance of this happening. It’s important to take the steroid tablets as you have been directed. Instead of steroid tablets, you may be given a steroid by injection into a vein (intravenously) 30-60 minutes before the paclitaxel. Other drugs, such as antihistamines, may also be injected into a vein before your treatment to prevent an allergic reaction.
You'll be closely monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms. If you do have a reaction, it can be treated quickly.
This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Some people find that paclitaxel causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
This may cause swelling of the ankles or breathlessness. Let your doctor know if you notice either of these effects.
Occasionally, flu-like symptoms may occur. You may have headaches, a high temperature, aching joints and muscles. It's important to let your doctor know immediately if you get a high temperature.
Treatment with GemTaxol 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.
Changes in heart rate
Rarely, GemTaxol can cause a temporary slowing of the heart rate known as bradycardia. This does not usually cause any harm.
Gemcitabine may cause drowsiness. If you feel drowsy, it’s important not to operate machinery or drive.
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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Pain along the vein
Paclitaxel can cause pain along the vein that is used to give you chemotherapy. If you feel any pain, tell your doctor or nurse straight away so that they can check the infusion site. They may slow the infusion down to reduce pain.
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.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
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 GemTaxol 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
Because of the effect of chemotherapy on the ovaries, women may find that their periods become irregular and 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.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
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.
This section is based on our GemTaxol chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. 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.