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This information is about a chemotherapy treatment for cancer called GemCarbo that is used to treat several different types of cancer, but is most commonly used to treat lung cancer. If you have any 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.
GemCarbo is named after the chemotherapy drugs used in the treatment, which are:
GemCarbo chemotherapy is usually given to you as a day patient. You will need a blood test before you start treatment – either on the same day, or a few days beforehand. You will 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 (see Possible side effects, below). 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. All of this may take several 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 cannula, which is connected to a drip (infusion), but some anti-sickness drugs can also be taken as tablets.
The chemotherapy drugs are then given separately:
If you are having your treatment as a day patient, you can then go home. 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 stopping it once it has started.
Your doctor may use the word 'regimen' (eg the GemCarbo regimen) when talking about your chemotherapy. This just means the whole plan or schedule of the particular treatment that you are receiving.
The GemCarbo regimen is given as a 21-day cycle. On the first day of your treatment you will have both the gemcitabine and carboplatin, as previously described. On the same day of the following week (day eight) you will have a drip of gemcitabine only. You will then have a rest period of two weeks. This completes a cycle of your chemotherapy.
You will start the next cycle of your treatment after the rest period, which will be three weeks after your first injection. Usually 4–6 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 who is having GemCarbo 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 do 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 GemCarbo 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, with your resistance to infection usually reaching its lowest point 10–14 days after your first dose of chemotherapy. Your production of blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or 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 GemCarbo can reduce the production of platelets (which help the 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 GemCarbo you may become anaemic. This may make you feel tired and breathless. Let your nurse or doctor know if these are a problem.
Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not 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.
Loss of appetite A dietitian or specialist nurse at the hospital can give advice on boosting your appetite, coping with eating difficulties and maintaining weight.
Tiredness Many people feel extremely tired (fatigued) during chemotherapy. This is a common side effect and it is important to try to get as much rest as you need.
Temporary effect on liver function Gemcitabine may cause changes in the way that your liver works, although 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 Gemcitabine 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.
Flu-like effects Occasionally, flu-like effects may occur with gemcitabine. You may have headaches, a high temperature and aching joints and muscles. It is important to let your doctor know about a high temperature immediately, as mentioned above.
Fluid retention This may cause swelling of the ankles or breathlessness. Let your doctor know if you notice either of these effects.
Mouth sore and ulcers If your mouth becomes sore, or you notice small ulcers, tell your nurse or doctor, who can prescribe suitable mouth care for you.
Diarrhoea This can usually be controlled with medicine, but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you do have diarrhoea.
Hair loss This is rare, but may occasionally occur. More commonly your hair may just thin. Hair loss is temporary and your hair will gradually return to normal once the treatment has finished.
Your kidneys may be affected This is a rare side effect and unlikely to cause any symptoms. The function of your kidneys may be checked by a blood test before each treatment. Sometimes a 24-hour urine test is also done.
Breathlessness Rarely, Gemcitabine can cause temporary narrowing of the airways, which can make you feel breathless. Let your doctor know if this is a problem.
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 medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Drowsiness Gemcitabine may cause drowsiness. Take care if you are driving or operating machinery after this treatment.
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 gemcitabine and carboplatin as these drugs may harm the developing foetus. It is important to use effective contraception while having the 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.
Allergic reaction Some people may have an allergic reaction to GemCarbo. Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, headache, breathlessness, anxiety and a desire to pass urine. Tell your doctor or nurse if you have any of these signs, as medicines can be given to reduce the reaction.
This section is based upon our GemCarbo 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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