GemCarbo (gemcitabine and carboplatin)

GemCarbo is the name of a chemotherapy combination used to treat non small cell lung cancer and bladder cancer. You are most likely to have this treatment if you have a more advanced non small cell lung cancer (stage 3 or 4). GemCarbo is made up of the drugs

• Gem = Gemcitabine
• Carbo = Carboplatin

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

There are a number of drug combinations for people with lung or bladder cancer. Your doctor will decide whether GemCarbo or another combination is best to treat your cancer. There is more information about chemotherapy combinations in the sections about lung cancer chemotherapy and bladder cancer chemotherapy.

You have the drugs into your bloodstream through a drip (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them 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.

You usually have chemotherapy as cycles of treatment. Each GemCarbo treatment cycle takes 3 weeks. A usual course of treatment consists of 4 to 6 cycles making 3 to 4 months. On the first day of the cycle you have gemcitabine and carboplatin. A week later you have gemcitabine only. You then have a two week break with no treatment before starting another cycle.

We have listed the side effects associated with GemCarbo below. You can use the links to find out more about each side effect. Where there is no link please see our cancer drugs side effects section or use the search box at the top of the page.

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 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
• Feeling or being sick is common but usually well controlled with anti sickness injections and tablets – it may last for quite a few days. Let your doctor or nurse know if it is not controlled as  there are other anti sickness drugs you can have
• Kidney changes that are mild and unlikely to cause symptoms may occur – they will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your kidneys are working
• Women may stop having periods (amenorrhoea) but this may only be temporary
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with these drugs. It is important to talk to your doctor about your fertility before starting treatment if having a baby is important to you
• Carboplatin and gemcitabine may have a harmful effect on a developing baby – it is not advisable to become pregnant or father a child if you are having this treatment. You should talk about contraception with your doctor before starting treatment.
• Liver changes that are very mild and unlikely to cause symptoms may occur – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working

Some people have the following side effects

• Hair loss or thinning
• Loss of appetite
• Carboplatin can change the taste of food and drinks
• Gemcitabine can cause diarrhoea or constipation
• A sore mouth or mouth ulcers
• A high temperature (fever) about 6 to 12 hours after having gemcitabine happens in about 4 out of every 10 people – it may last about 12 hours. This is a reaction to the drug, and does not mean you have an infection. Taking paracetamol every 6 to 8 hours should control your temperature
• Flu like symptoms occur in about 2 in 10 people having gemcitabine and start a few hours after the infusion – the effects include headaches, muscle aches, a raised temperature and shivering
• A skin rash, which may itch, occurs in about 1 in 4 patients
• Swelling in the face, hands and feet occur in about 3 out of every 10 patients – this usually goes away on its own but tell your doctor or nurse if you notice any swelling
• Wheeziness or breathlessness occur in about 1 in 12 people treated with gemcitabine, caused by inflammation of the lungs
• Drowsiness affects about 1 in 10 people – this usually goes away on its own but tell your doctor or nurse
• Numbness or tingling in fingers and toes happen in about 1 out of 25 people (4%) and can cause difficulty with fiddly things such as doing up buttons – it starts within a few days or weeks and usually goes within a few months of finishing treatment
• Some people have an allergic reaction while having GemCarbo treatment, usually at the first or second treatment – let your treatment team know immediately if you have any skin rashes, itching, feeling hot, shivering, going red in the face, feeling dizzy, headache, shortness of breath, anxiety or a sudden need to pass urine

A very few people may have ringing in the ears (tinnitus) or damaged hearing (especially loss of high tones) after GemCarbo treatment.

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.