Gemcitabine and cisplatin chemotherapy
This information is about a chemotherapy treatment using
gemcitabine and cisplatin, which is used to treat several different types of cancer. Gemcitabine and cisplatin chemotherapy may sometimes be referred to as GemCis or GemCisplat.
The drugs that are used
Back to top
The treatment involves the two chemotherapy drugs gemcitabine and cisplatin.
How treatment is given
Back to top
Your chemotherapy can usually be given to you as a day patient. Before you start your treatment you'll need to have a blood test, either on the same day or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. You will also have tests to check how well your kidneys are working, as the chemotherapy can affect them. These may include collecting your urine for 24 hours or having a specific blood test known as an EDTA test. If the results of your tests are normal, the pharmacy will prepare your chemotherapy drugs. This may take several hours.
The nurse will insert a thin, flexible tube (cannula) into a vein in your arm. 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 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 more about this to you.
Once your chemotherapy is ready, you'll be given an anti-sickness (anti-emetic) drug. This is usually given through the cannula, but some anti-sickness drugs can also be taken as tablets.
Before having the chemotherapy, you'll be given a drip (infusion) of saline (salt water) for half an hour or more. You may also receive an infusion of a drug called mannitol with your chemotherapy. Cisplatin can affect the kidneys, and giving the infusions of saline and mannitol can help prevent any damage.
The chemotherapy drugs are then given to you separately:
gemcitabine (a colourless fluid) is given as an infusion that takes about half an hour
cisplatin (a colourless fluid) is also given as an infusion, which may last 1-4 hours.
After the chemotherapy has finished, you'll be given more saline through the drip.
If you are having your treatment as a day patient you can then go home, 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 your next cycle of 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 these regularly if you have been directed 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
Back to top
Your doctor may use the word 'regimen' (eg the GemCisplat regimen) when talking about your chemotherapy. This means the whole plan or schedule of your particular chemotherapy treatment.
GemCisplat can be given in different ways. You can ask your nurse or doctor to explain which way you will have your treatment.
On the first day of your treatment you will be given infusions of cisplatin and gemcitabine. The gemcitabine is then repeated one week later (day eight). After this you will have a rest period of two weeks with no chemotherapy. This completes what is called a cycle of your chemotherapy treatment. Each cycle lasts for 21 days (three weeks).
You will start the next cycle of your treatment after the rest period. Usually 4-6 cycles of treatment are given over a period of 3-4 months. This makes up a course of treatment.
Alternatively, your treatment can be given in a four-week (28-day) cycle. On day one you will be given infusions of cisplatin and gemcitabine. On days 8 and 15, you will be given gemcitabine only. This is then followed by two weeks of rest before starting the next cycle of chemotherapy.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described below won't affect everyone having treatment with cisplatin and gemcitabine.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed below, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
GemCisplat can 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 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
GemCisplat 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.
GemCisplat 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) and being sick (vomiting)
This is common and may begin soon after the treatment is given and last for a few days. Occasionally it may last longer. Your doctor can prescribe very effective 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 be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Your kidneys may be affected
This doesn't usually cause any symptoms, and the effect is generally mild. Rarely, this treatment may cause permanent damage to the kidneys unless the treatment is stopped.
Before each treatment, your kidneys will be checked by a blood test. You’ll be given fluid through a drip (infusion) before and after the treatment to keep your kidneys working normally. You may be asked to measure and record both what you drink and the amount of urine you pass. It’s important to tell your nurse or doctor if you pass less urine than usual.
If necessary, you may be given medicine to help you to pass urine. You may be asked to drink extra fluid before and after treatment. It's important to do this, so let your doctor know if this is a problem - for example, if you're feeling sick.
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.
Gemcitabine can cause a rash or dry skin, which may be itchy. Your doctor can prescribe medicine to help with this.
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.
Less common side effects
Back to top
Numbness or tingling in hands or feet
This is due to the effect of cisplatin 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 is 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.
Changes in hearing
Cisplatin may cause ringing in the ears (tinnitus), and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally your sense of balance may be affected. Any hearing loss, and balance changes if they occur, may be permanent. However tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
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.
GemCisplat can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Treatment with gemcitabine may cause changes in the way that 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.
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 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.
This is rare with this treatment, but your hair may become thinner. If you lose any hair it will grow back once the treatment has finished. Your nurse can give you advice about coping with hair loss.
Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety and a feeling that you want to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse about any side effects you have.
Rarely, gemcitabine can cause temporary narrowing of the airways, which can make you feel breathless. Let your hospital doctor if this is a problem.
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.
Back to top
Gemcitabine may cause drowsiness. Take care if you are driving or operating machinery following the treatment.
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 are having chemotherapy. Tell your doctor about any medicines you are 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 GemCisplat, as it may harm the developing baby. It's important to use effective contraception while taking this drug, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
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.
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 upon our gemcitabine and cisplatin chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
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.
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.