Gemcitabine and paclitaxel (GemTaxol)

GemTaxol is the name of a combination of chemotherapy drugs used to treat breast cancer. This combination of drugs is also being researched for other types of cancers. It is made up of the drugs

• Gemcitabine (also called Gemzar)
• Paclitaxel (also known as Taxol)

The links above take you to more information about the individual side effects of each drug.

The side effects of a combination of drugs are usually a mixture of those of each drug. You may get some or all of the side effects. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with GemTaxol are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drug side effects section.

Gemcitabine and paclitaxel are clear colourless fluids. You have these drugs into your bloodstream (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 as long as you need it.

You usually have GemTaxol chemotherapy as cycles of treatment. You may have 4 to 6 cycles over 3 to 5 months. Each cycle of treatment lasts 3 weeks.

On the first day, you have drips (infusions) of gemcitabine and paclitaxel. The gemcitabine drip takes about half an hour and paclitaxel takes 3 hours. For the next 6 days you have no treatment. On day 8 you have a gemcitabine drip. Then you have no treatment for 2 weeks. This completes one treatment cycle and you then start again.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• 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. You may have injections just under the skin of your abdomen to make your bone marrow produce more white blood cells.
• 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 affects about 7 out of every 10 people (70%), but is usually well controlled with anti sickness drugs
• Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons – this begins within a few days or weeks and usually goes within a few months after treatment ends
• Complete hair loss affects most people but this is temporary – your hair will grow back when treatment ends
• Aching joints (arthralgia) and aching muscles (myalgia) affect about 6 out of 10 people (60%) who have paclitaxel – it may start a couple of days after treatment and last for about 5 days
• Diarrhoea – drink plenty of fluid and tell your doctor if diarrhoea becomes severe, or continues for more than 3 days
• A sore mouth 
• Mild allergic reactions in about 1 out of 5 people (20%) who have paclitaxel – let your treatment team know if you have a rash or redness of the face. Usually you have steroids before treatment to prevent a reaction, but a few people may have a more severe allergic reaction. Let your treatment team know immediately if you have any skin rashes, itching, shivering, a red face, headache, shortness of breath, anxiety, feel dizzy or hot, or have a sudden need to pass urine
• Flu like symptoms (headaches, muscle aches, a high temperature and shivering) affect about 2 out of 10 people (20%) within a few hours of having gemcitabine – paracetamol can help
• Swelling in your face, hands and feet affects about 3 out of every 10 people (30%) – it usually goes away on its own, but let your doctor know if you have it
• A skin rash, which may itch, in about 1 out of 4 people (25%)
• These drugs may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Drowsiness (somnolence) affects about 1 out of 10 people (10%) treated with gemcitabine and you may be very sleepy after treatment – this usually goes away on its own, but tell your treatment team if you have it

Between 1 and 10 in every 100 people have one or more of these.

• Wheeziness or breathlessness affects about 1 out of 12 people (8%) 
• Women may stop having periods (amenorrhoea) – this may be temporary
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk to your doctor before starting treatment if having a baby is important to you
• Low blood pressure
• Slowing of the heart rate (bradycardia)
• Abdominal pain
• Temporary taste changes
• Headaches
• Liver changes that are very mild and unlikely to cause symptoms – the liver usually goes back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working
• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your doctor or chemotherapy nurse immediately

Not everyone will get these side effects. They may be mild or more severe. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much 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 they can help you manage them. Your nurse will give you a contact number. You can ring them 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.