Gemcitabine and cisplatin chemotherapy
Gemcitabine and cisplatin chemotherapy (GemCis or GemCisplat) is a chemotherapy treatment used to treat several different types of cancer.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
How treatment with gemcitabine and cisplatin is given
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The treatment involves two chemotherapy drugs:
You have your treatment in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness drugs as an injection into a vein or as tablets. They will give you the drugs and chemotherapy through one of the following:
a short thin tube (cannula) that the nurse puts into a vein in your arm or hand
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Before having the chemotherapy, you'll be given a drip (infusion) of saline (salt water) for about half an hour. You may also be given an infusion of a drug called mannitol with your chemotherapy. Cisplatin can affect the kidneys, and giving saline and mannitol can help prevent any damage.
Your nurse will give you gemcitabine (a colourless fluid) as a drip, which takes about half an hour. After this, they will give you cisplatin (a colourless fluid) as a drip, which takes 1–4 hours. They usually run the drip through a pump, which gives you the treatment over a set time. After the chemotherapy has finished, you'll be given more saline through the drip.
When the chemotherapy is being given
Some people might experience the following side effects while they are having the chemotherapy:
Rarely, your treatment may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
Rarely, gemcitabine can cause temporary narrowing of the airways, which can make you feel breathless. Let your doctor know if this is a problem.
GemCisplat may cause flu-like symptoms such as: feeling hot or cold and/or shivery, having a headache and aching. You may have these symptoms while the drug is being given or several hours after. Your nurse will tell you if this is likely to happen. They may advise you to take paracetamol. Drinking plenty of fluids will also help.
If the symptoms are severe or don’t improve after 24 hours, contact the hospital.
Your course of gemcitabine and cisplatin
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of gemcitabine and cisplatin takes 21 days (three weeks).
On the first day, you will have gemcitabine and cisplatin. A week later (day eight of the cycle), you’ll have gemcitabine again. After this, you’ll have a rest period of one week with no chemotherapy.
At the end of the 21 days, you will start your second cycle of treatment. This is exactly the same as the first cycle. You have up to six cycles over 18 weeks. Your doctor or nurse will tell you the exact number of cycles that you are likely to have.
Alternatively, you can have your treatment in a four-week (28-day) cycle. On day one, you will have infusions of cisplatin and gemcitabine. On days eight and 15, you’ll have gemcitabine only. This is then followed by two weeks of rest before starting the next cycle.
There are other courses of gemcitabine and cisplatin. Your doctor can explain how long your cycle of treatment will be and when you will have treatment.
Before you go home, the nurse or pharmacist will give you anti-sickness drugs to take. They may also give you anti-diarrhoea tablets if you need them. Take all your tablets exactly as the nurse or pharmacist has explained.
We explain the most common side effects of gemcitabine and cisplatin here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention, but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these. It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
GemCisplat can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. Your white blood cells start to reduce seven days after treatment and are usually at their lowest 10–14 days after. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
GemCisplat can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
GemCisplat can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Changes in the way the kidneys work
Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this. You’ll have extra fluids through a drip before and after chemotherapy. This is to protect your kidneys.
Your nurse will ask you to drink plenty of fluid. Tell them if there are any changes in how much urine you are producing.
Loss of appetite
You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
Chemotherapy may affect your skin. If your skin feels dry, try using an unperfumed moisturising cream every day. Gemcitabine can cause a rash, which may be itchy. Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and should improve when treatment finishes.
Build up of fluid
You may put on weight or your ankles and legs may swell because of fluid building up. Tell your doctor or nurse if this happens. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion. The swelling gets better after your treatment ends.
Less common side effects
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Numb or tingling hands or feet
These symptoms are caused by the effect of cisplatin on nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but in some people they may never go away. Talk to your doctor if you are worried about this.
Changes in hearing
Cisplatin can affect your hearing. You may have a hearing test before you start treatment. You may get ringing in your ears (tinnitus) and lose the ability to hear some high-pitched sounds. Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing.
You may get a bitter or metallic taste in your mouth or find that food tastes different. This should go away when your treatment finishes. Try using herbs and spices (unless you have a sore mouth or ulcers) or strong-flavoured sauces to give your food more flavour. Sucking boiled sweets can sometimes help get rid of a bitter or metallic taste. Your nurse can give you more advice.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Changes to the way the liver works
Gemcitabine may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
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 here.
Other information about gemcitabine and cisplatin
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Gemcitabine may cause drowsiness. Take care if you are driving or operating machinery following the treatment.
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some other medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
GemCisplat may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using information from a number of reliable sources, including:
British National Formulary. 66th edition. British Medical Association and Royal Pharmaceutical Society of Great Britain. 2013.
electronic Medicines Compendium (eMC). medicines.org.uk (accessed November 2013).
Perry MC. The Chemotherapy Source Book. 5th edition. Lippincott Williams and Wilkins. 2012.
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. Pharmaceutical Press. 2011.
With thanks to Christine Clarke, Lead Pharmacist Oncology & Haematology, who reviewed this edition.
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