GemCap

GemCap is the name of a chemotherapy treatment used to treat cancer of the pancreas. Doctors are also researching it for cancers of the gallbladder and bile duct. GemCap is a combination of the 2 drugs

• Gemcitabine
• Capecitabine

You can click on the links to find out about the side effects of each individual drug. The side effects of a combination of drugs are usually a mixture of the side effects of each drug. The combination of drugs may increase or decrease your chance of getting each side effect. Or it may change the severity.

You usually have GemCap chemotherapy in cycles of treatment which last 4 weeks. You usually have 6 cycles over 6 months.

Each cycle is given in the following way. You have a weekly injection of gemcitabine for 3 weeks. You have it into your bloodstream (intravenously). You can have it by drip through a thin tube (cannula) that goes into one of your veins. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it. The gemcitabine takes about half an hour.

You also take a capecitabine tablet twice a day for 3 weeks. You start the tablets on the same day as you start the gemcitabine. You then have a break, with no treatment, during the fourth week. You then start the next treatment cycle.

The side effects associated with GemCap are listed below. Use the links (underlined) to find out more about each side effect. For more information on side effects where there is no link please see our cancer drugs side effects section, or use the search box at the top of the page.

It is important to store capecitabine tablets in a safe place away from children. Take any unused tablets back to the pharmacy.

With these drugs, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these side effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Flu like symptoms in 4 out of 10 people (40%), including a raised temperature, muscle aches and shivering – these start a few hours after the gemcitabine drip and you can take paracetamol to help
• Soreness, redness and peeling on the palms of the hands and soles of the feet (palmar plantar syndrome) which may cause tingling, numbness, pain and dryness
• GemCap may have a harmful effect on a developing baby so it is not advisable to become pregnant or father a child whilst having this treatment – discuss contraception with your doctor before having the treatment
• Women may stop having periods but this may only be temporary
• Loss of fertility – you may not be able to get pregnant or father a child after having this treatment so if having a baby is important for you, talk to your doctor about fertility before starting treatment
• Feeling or being sick is usually well controlled with anti sickness tablets and injections – if you still have sickness after taking these, tell your doctor
• Diarrhoea occurs in around half the people who have capecitabine – it can be quite severe but is usually well controlled with medicines. Drink plenty of fluids and if diarrhoea becomes severe or continues tell your doctor or nurse immediately. Make sure you follow any special advice you have been given about how to cope with diarrhoea

Some people have the following side effects

• Loss of appetite
• Mouth ulcers – let your doctor know if your mouth gets very sore and it is painful to eat. You can have painkillers and mouthwashes to help
• Hair thinning
• Abdominal pain
• Constipation is generally well controlled with laxatives but if you are constipated for more than 3 days, tell your doctor or nurse
• Swelling in the face, hands and feet occurs in about 3 out of every 10 people (30%) – it usually goes away on its own, but tell your doctor if you notice any swelling
• Headaches and dizziness
• Eye problems, including increased production of tears and infections
• Higher levels of bilirubin in your blood caused by capecitabine – you will have regular blood tests to check the levels

A very small number of people have the following side effects

• Swollen ankles
• Chest pain
• Wheeziness or breathlessness due to inflammation of the lungs – tell your doctor if you have this side effect

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.