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This information is about a chemotherapy treatment for cancer that uses gemcitabine and capecitabine, called GemCap. GemCap is most commonly used to treat cancer of the pancreas, but may be used to treat several different types of cancer. If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
GemCap is named after the drugs used and involves the chemotherapy drugs:
GemCap chemotherapy is usually given to you as a day patient. Before you start treatment you will need a blood test, either on the same day or a few days before. You will 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 tube (cannula) into a vein in your arm or hand. You may find this uncomfortable or a little painful but it should not take long. Some people have their chemotherapy given through a thin plastic tube that is inserted under the skin into a vein near the collarbone (central line) or through a vein in their arm (PICC line).
You will be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the central line, PICC line or cannula, which is connected to a drip (infusion), but some anti-sickness medicines may be given as tablets.
The chemotherapy drugs are then given to you separately:
Capecitabine is usually given as a combination of 500mg and 150mg tablets. You need to make sure that you are taking the right dose. The tablets should be swallowed whole and with a glass of water, within half an hour of the end of a meal. You should take them in the morning after breakfast, and then again after your evening meal, so that your doses are spaced at least eight hours apart.
If you are having your treatment as a day patient, you can go home after the gemcitabine infusion. The cannula will be removed and you will be given a supply of anti-sickness tablets to take with you. It is important to take these as directed even if you are not feeling sick, as some anti-sickness drugs are much better at preventing sickness than at stopping it once it starts.
Your doctor may use the word 'regimen' (eg the GemCap regimen) when talking about your chemotherapy. This just means the whole plan or schedule of the particular treatment that you are receiving.
On the first day of your treatment you will have an infusion of gemcitabine. You will also start taking the capecitabine tablets. It is important to follow the instructions carefully and take the tablets as directed by your doctor. One week later (day eight), you will have a second infusion of gemcitabine.
When you have finished taking the capecitabine tablets you will have a rest period, with no chemotherapy, for one week. This completes a cycle of your chemotherapy. Each cycle lasts for 21 days (three weeks).
Following this rest period, three 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 in this information will not affect everyone having GemCap chemotherapy.
We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drug, but which are not listed in this information, please let your nurse or doctor know.
Lowered resistance to infection GemCap can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact the hospital straightaway if:
You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.
Bruising or bleeding GemCap can reduce the production of platelets, which help your blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Anaemia (low number of red blood cells) While having treatment with GemCap you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are a problem.
Feeling sick (nausea) and being sick (vomiting) This is usually mild and there are very effective anti-sickness (anti-emetic) drugs to reduce or prevent nausea and vomiting. If the sickness is not controlled, or 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.
Sore mouth and ulcers Your mouth may become sore 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. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.
Taste changes You may also notice that your food tastes different. Normal taste will come back after the treatment finishes.
Diarrhoea This can be quite severe, but can usually be controlled with medicines. If you have diarrhoea more than 4–6 times a day, contact your specialist for advice immediately. You may be advised to stop taking capecitabine; however, it is often possible to restart the treatment at a lower dose. It is important to drink plenty of fluids if you have diarrhoea.
Abdominal pain and constipation It may help to drink plenty of fluids, eat a high-fibre diet and take gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. These can be prescribed by your doctor.
Loss of appetite A dietitian or specialist nurse at the hospital can give advice on boosting your appetite, coping with eating problems and maintaining weight.
Temporary effect on liver function Gemcitabine may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. You are unlikely to notice any problems but you will have a blood test to check your liver function before each treatment.
Skin changes GemCap can cause a rash, which may be itchy. Your doctor can prescribe medicines to relieve the symptoms. You may also notice some swelling of your ankles. This is usually mild and goes away after the treatment is finished. Soreness and redness, or darkening, of the palms of your hands and soles of your feet (sometimes known as palmar plantar syndrome or hand-foot syndrome) can also occur. You may be prescribed vitamin B6 (pyridoxine), which can help to reduce this.
Flu-like illness Occasionally, flu-like illness may occur with gemcitabine. You may have headaches, a high temperature and aching joints and muscles. If you have a high temperature, it is important to let your specialist or chemotherapy nurse know immediately.
Fluid retention This may cause swelling of the ankles, or breathlessness. Let your doctor know if you notice either of these effects.
Tiredness Many people feel extremely tired (fatigued) during chemotherapy. This is a very common side effect and it is important to try to get as much rest as you need.
Hair loss Your hair may thin or occasionally be lost completely, though this is uncommon. If this happens, it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. Hair loss is temporary, and your hair will start to grow again once the treatment is finished.
Changes in hearing 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.
Breathlessness Rarely, gemcitabine can cause temporary narrowing of the airways, which can make you feel breathless. Contact your doctor if you feel breathless.
Headaches and dizziness This may be caused by capecitabine. Tell your doctor if you have headaches or feel dizzy and lightheaded.
Increased production of tears This may be caused by capecitabine, and is temporary.
Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.
Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having 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 is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medicines you are taking, including non-prescribed drugs, such as complementary therapies and herbal drugs.
Fertility Your ability to become pregnant or father a child may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while having GemCap, as these drugs may harm the developing foetus. It is important to use effective contraception while having treatment, and for at least a few months afterwards. Again, discuss this with your doctor.
Loss of periods Due to the effect of chemotherapy on the ovaries, women may find that their periods become irregular and may eventually stop. In younger women this may be temporary, but in women closer to their menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
Interaction with other drugs Capecitabine may affect the action of some blood-thinning medicines (anti-coagulants), such as warfarin. Let your doctors know if you take warfarin, as they may need to carry out more frequent checks to see how quickly your blood is clotting.
Folic acid Let your doctor know if you are taking folic acid because this might increase the side effects of capecitabine.
Drowsiness Gemcitabine may cause drowsiness. Take care if you are driving or operating machinery following this treatment.
This section is based upon our GemCap chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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