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This information is about a chemotherapy treatment for cancer using gemcitabine and cisplatin, which is used to treat several different types of cancer. Gemcitabine and cisplatin chemotherapy may be referred to as GemCis or GemCisplat. 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.
The treatment involves the two chemotherapy drugs gemcitabine, which is also known as Gemzar®, and cisplatin.
Your chemotherapy can usually be given to you as a day patient. Before you start your treatment you will 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. If the results of your blood test are normal the pharmacy will prepare your chemotherapy drugs. All of this can take several hours.
The nurse will then put a fine tube (cannula) into a vein in your arm. 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 long, thin flexible tube (known as a PICC line) that is inserted at the bend in the elbow. Your doctor or nurse will explain more about this to you.
Once your chemotherapy is ready you will 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 will 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 to prevent any damage.
Usually, the gemcitabine (a colourless fluid) is given first, which takes half an hour. Then the cisplatin (a colourless fluid) is given, which may last between 1–4 hours. After the chemotherapy has finished you will be given more saline through the drip.
If you are having your treatment as a day patient you can then go home. If you have a cannula, it will be removed and you will be given a supply of anti-sickness drugs to take with you. You should take these regularly if you have been directed to do so, even if you are not feeling sick. It is easier to prevent sickness than to stop it once it has started.
GemCisplat can be given in different ways. You can ask your nurse or doctor to explain which way you will have your treatment. You may hear your doctor or nurse use the word 'regimen' (eg the GemCisplat regimen) when talking about your chemotherapy. This just means the whole plan or schedule of the particular treatment that you are receiving.
GemCisplat is given in cycles of treatment. Each cycle typically takes three weeks (21 days). On the first day of each cycle, you will have both the cisplatin and the gemcitabine. The gemcitabine is then repeated one week later (day 8). After this, you will have a rest period of 13 days.
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 cisplatin and gemcitabine. On days 8 and 15, you will be given gemcitabine only. This is then followed by 13 days' 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 will not affect everyone who is having treatment with cisplatin and gemcitabine.
We have outlined the most common side effects, but 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 GemCisplat 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 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:
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 GemCisplat 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 GemCisplat 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) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled by the tablets you are given, it is important to let your specialist know, as other medicines can be given. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Your kidneys may be affected Cisplatin can affect the kidneys. Usually this does not cause any symptoms and the effect on the kidneys is mild. If the effect is severe, the kidneys can be permanently damaged unless the treatment is stopped. For this reason your kidney function will be checked with a blood test before the cisplatin treatment is given.
Plenty of fluid is given beforehand, and you may be given an infusion of mannitol to keep your kidneys working normally. You may be asked to measure and keep a record of what you drink and the amount of urine that you pass on the days you are having cisplatin. If necessary, you may be given medicine to help you pass urine. If you are asked to drink extra fluid it is important to do this or to let your doctor know if this is a problem – for example, if you are feeling sick.
Loss of appetite A dietitian or specialist nurse at the hospital can give you advice on boosting your appetite, coping with eating difficulties and maintaining weight.
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.
Flu-like illness Occasionally a flu-like illness may occur with gemcitabine. You may have headaches, aching joints and muscles and fevers. You should always let your doctor know immediately if you have a high temperature.
Fluid retention This may cause swelling of the ankles or breathlessness. Let your doctor know if you notice either of these effects.
Numbness or tingling in hands or feet This can be due to the effect of cisplatin on the nerves and is known as peripheral neuropathy. You may notice that you have difficulty doing up buttons or similar fiddly tasks. These symptoms should improve over a few months once the treatment has finished. Let your doctor know if you have any numbness or tingling in your hands and feet.
Changes in hearing You may have ringing in the ears (tinnitus) and you may lose the ability to hear some high-pitched sounds. Again this usually gets better when the treatment ends. Tell your doctor if this happens to you.
Temporary taste alterations A dietitian or specialist nurse at your hospital can give you advice. Normal taste usually returns once the treatment has finished.
Diarrhoea This can usually be easily 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 have diarrhoea.
Temporary effect on liver function Gemcitabine may cause changes in the way that your liver works. However, your liver will return to normal when the treatment has finished. You are very unlikely to notice any problems but your doctor will check your liver function before each treatment.
Mouth sores 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 doctor or nurse if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.
Hair loss This is rare but can sometimes occur with gemcitabine. More commonly your hair may just thin. Hair loss is temporary and your hair will return to normal once the treatment has finished.
Allergic reaction Signs of an allergic reaction include skin rashes and itching, high temperature, shivering, redness of the face, dizziness, headache, breathlessness, anxiety and a need to pass urine. You will be monitored for signs of an allergic reaction during the treatment. Let your nurse or doctor know if you feel unwell or develop any of these symptoms.
Changes to the lungs Gemcitabine may cause some changes to lung tissue. Tell your doctor if you notice any coughing or breathlessness.
Drowsiness Gemcitabine may cause drowsiness. Take care if you are driving or operating machinery following the treatment.
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.
Fertility Your ability to become pregnant or to father a child may be affected by taking these drugs. 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 chemotherapy, as the developing foetus may be harmed. Again, discuss this with your doctor.
This section is based upon our gemcitabine and cisplatin chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see general bibliography.
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