This information is about a chemotherapy treatment for cancer called GemTaxol. It describes the drugs used, how they are given and some of the possible side effects. GemTaxol chemotherapy is most commonly used to treat advanced breast cancer but may be used to treat several different types of cancer in the future. 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.

GemTaxol is named after the chemotherapy drugs used, which are:

• gemcitabine, which is also known as Gemzar®
• paclitaxel, which is commonly called Taxol.

GemTaxol chemotherapy is usually given to you as a day patient. You will need a blood test before the start of your treatment – either on the same day, or a few days beforehand. You will 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 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).

Once your chemotherapy treatment is ready 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 be taken as tablets. You will also be given a 'premed' to help prevent an allergic reaction to the Taxol. This involves an injection into the drip of a steroid drug called dexamethasone (or you may be given steroid tablets to take instead). You will also be given a drug to protect your stomach from the irritation that dexamethasone can cause. This will be given to you either as an injection into your drip, or as tablets.

Your chemotherapy is then given to you as follows:

• gemcitabine (a colourless fluid) in a drip (infusion) that lasts about 30 minutes
• Taxol (a colourless fluid) in a drip that takes three hours.

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 drugs to take home with you. You should take them regularly if you have been told to do so, even if you are not feeling sick. This is because some medicines are much more effective at preventing sickness than stopping it once it has started.

Your doctor may use the word 'regimen' (eg the GemTaxol regimen) when talking about your chemotherapy. This just means the whole plan or schedule of the particular treatment that you are receiving.

The GemTaxol regime is given as a 21-day cycle. On the first day of your treatment, you will have both the gemcitabine and Taxol – as previously described. On the same day of the following week (day 8) 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 3–5 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 in this information will not affect everyone having GemTaxol 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 that are not listed in this information, please let your nurse or doctor know.

Lowered resistance to infection Gemcitabine and Taxol can both 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 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 your doctor or the hospital straightaway if:

• your temperature goes above 38 °C (100.5 °F)
• you suddenly feel unwell (even with a normal temperature).

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 Gemcitabine and Taxol can also reduce the production of platelets, which can 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 GemTaxol you may become anaemic. This may make you feel tired and breathless. Let your doctor know if these effects 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 which may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem.

Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.

Hair loss This usually starts 2–3 weeks after the first course of treatment (and is due to Taxol). Hair is usually lost completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to grow again once the treatment is finished.

Sore mouth and ulcers Your mouth may become sore or you may notice small ulcers during this treatment. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection. Using a soft toothbrush may also be helpful.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Numbness or tingling in hands or feet This is due to the effect of paclitaxel on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these effects. The problem usually improves slowly a few months after treatment is over.

Aching joints and muscles You may have these symptoms a few days after treatment (due to the Taxol). This does not usually last long and your doctor can prescribe mild painkillers to help.

Abdominal pain This can develop a few days after finishing Taxol and may last for a few days. Your doctor can prescribe regular painkillers if it does happen.

Skin changes Gemcitabine can cause a rash which may be itchy. Your doctor can prescribe medication to relieve the symptoms. You may also notice some swelling in your ankles. This is usually mild and goes away after the treatment has finished.

Allergic reaction Some people can have an allergic reaction to paclitaxel. Signs of this can include skin rashes and itching, a high temperature, shivering, dizziness, headache and breathlessness. You will be given medicine (a steroid) before treatment to reduce the chance of this happening. Let your nurse or doctor know if you have any of these symptoms. A reaction can be treated quickly.

Diarrhoea This may occur several days after the treatment. Diarrhoea can usually be easily controlled with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2–3 litres of fluid a day to replace the fluid you are losing.

Headaches Some people find that paclitaxel causes headaches. Let your doctor know if this happens to you.

Fluid retention This may cause swelling of the ankles and breathlessness. Let your doctor know if you notice this.

Flu-like illness Occasionally a flu-like illness may occur with gemcitabine. You may have headaches, aching joints and muscles, and fevers. If you have a high temperature you should let your doctor know immediately.

Temporary effect on liver function GemTaxol 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.

Changes in heart rate Rarely, Taxol can cause a temporary slowing of the heart rate known as bradycardia. This usually does not cause any harm.

Drowsiness Gemcitabine may cause drowsiness. Take care if you are driving or operating machinery following this treatment.

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.

Pain on injection Taxol can cause pain while it is being given – either at the site of the injection, or along the vein. If you feel pain, tell your doctor or nurse. They can slow the drip down to reduce the feeling.

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 taking this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking these drugs and for at least a few months afterwards. Again, discuss this with your doctor.

Loss of periods in women Due to the effect of chemotherapy on the ovaries, you may find that your periods become irregular and may eventually stop. In some women this may be temporary, but for others it may be permanent. If your periods stop permanently this will result in menopausal symptoms such as hot flushes and sweats.

This section is based upon our GemTaxol chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see the general bibliography.