Gemcitabine and capecitabine (GemCap)

GemCap is the name of a chemotherapy combination. It includes the drugs below. How to pronounce the drug names are in brackets. 

• gemcitabine (jem-site-uh-been)

• capecitabine (ka-pe-site-a-been)

It is a treatment for pancreatic cancer.

How does GemCap work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do you have GemCap?

You have gemcitabine as a drip into your bloodstream (intravenously). 

Capecitabine is a tablet you take twice a day, after food. You swallow the tablets with water within 30 minutes of finishing a meal.

Drugs into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Taking your tablets

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

How often do you have GemCap?

You usually have GemCap chemotherapy in cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover. Each cycle lasts 28 days (4 weeks).

You might have up to 6 cycles of treatment. Or you may have GemCap for as long as it is working, and the side effects aren't too bad. 

How long you have it for will depend on your situation. Your healthcare team will tell you more about this. 

You have each cycle of treatment in the following way: 

You then start the cycle again. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before starting treatment with capecitabine you have a blood test to check levels of an enzyme called dihydropyrimidine dehydrogenase (DPD). A low DPD level means you are more likely to have severe side effects from these drugs. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor, pharmacist or nurse will talk to you about this.

What are the side effects of GemCap?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects

• your side effects aren’t getting any better

• your side effects are getting worse

• the side effects are affecting your daily life

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Less often you might have bleeding from other areas of the body. Let your doctor or nurse know if this happens.

Tiredness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

You might also feel weak or lacking energy. This is called asthenia.

Flu like symptoms

This can happen a few hours after treatment. It may include headaches, muscle aches (myalgia), a high temperature and shivering. Talk to your nurse about this. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Soreness, redness, and peeling on palms and soles of the feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Diarrhoea can be severe, but it's usually well controlled with medicines. 

Liver changes 

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Rarely, you might get yellowing of the skin or whites of the eyes (jaundice).  

Blood and protein in your urine

Small amounts of blood and protein in your urine may be found when your nurse tests your urine. This usually goes away on its own. If there are large amounts of protein you may have tests to check how well your kidneys are working.

Fluid build up 

A build up of fluid may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your healthcare team if this happens to you.

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Sore mouth and ulcers 

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Skin problems

Skin problems include an allergic skin rash, which is red and itchy.

Less often these drugs can make your skin dry and you might develop skin colour changes. Your skin might become more sensitive to sunlight and areas of skin that have been treated with radiotherapy in the past can become sore, irritated and inflamed. 

Rarely you might develop a skin reaction that is serious and could be life threatening. It may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light.

Let your healthcare team know straight away. They can give you advice on what to do and what products you can use on your skin to help.

Difficulty breathing 

You may have shortness of breath with wheezing and coughing. This could be the cause of different lung problems. Let your doctor or nurse know straight away if this happens. 

Numbness or tingling in fingers or toes 

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Nail problems 

Your nails might break more easily, or slightly change colour.

Loss of appetite 

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Soreness, redness and peeling on palms and soles of feet 

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Runny or blocked nose

You might have sneezing or a congested, itchy, runny nose.

Difficulty sleeping (insomnia)

If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and10%). You might have one or more of them. They include:

• constipation
• feeling very drowsy – do not drive or operate heavy machinery and if it becomes severe tell your doctor
• headaches and dizziness
• eye problems such as infections and increased production of tears. Rarely, you may get eye pain, blurred or double vision. Let your team know if this happens
• hiccups
• heartburn or indigestion
• passing wind (flatulence)
• dry mouth
• pain in your chest, joints, back. arms or legs. Rarely, you might have pain in your bones or face. Let your team know if this happens
• generally feeling unwell (malaise)
• depression
• nosebleed
• sweating
• fever or chills
• low levels of fluid in the body dehydration
• muscle aches and pains
• cold sores or other Herpes infections
• taste changes
• blood clots in veins near the surface of your skin (thrombophlebitis) or more rarely in deep muscles (deep vein thrombosis, DVT). DVTs can be life threatening. Signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• bleeding in the gut. This might be due to a drop in the number of platelets in the blood, which help your blood to clot
• skin and nail problems such as skin rashes, dry skin, itching, changes in skin colour, and darkening or brittle nails

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• heart problems such as changes to your heart rhythm, pounding or fluttering feeling (palpitations) or heart attack

• non cancerous (benign) lumps under the skin (lipoma)

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life-threatening alert your nurse or doctor if you notice any of these symptoms

• changes to the level of substances in the blood such as high levels of fats in the blood (triglycerides) and sugar levels (diabetes). Or you might have low levels of potassium.

• mood and behavioural changes such as confusion, panic attacks, feeling low and loss of interest in sex (libido)

• nerve problems such as difficulty speaking, uncoordinated body movements so you might find it difficult to walk and have poor balance, and memory changes

• passing out (fainting)

• inflammation of the digestive system (colitis)

• swelling and stiffness of the joints

• muscle stiffness and weakness

• hot flushes

• kidney problems such as passing lots of urine at night, leaking urine (incontinence) – you will have regular blood tests to check for this

• dizziness, rarely it may feel like the area around you is spinning and you may lose your balance (vertigo)

• tooth abscess

• problems with the way your blood clots

• ear pain

• heavy vaginal bleeding

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

It is not known whether these drugs come through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.