R-GCVP

R-GCVP is the name of a cancer drug combination. It includes the drugs below. How to pronounce the drug names are in brackets.

• R – rituximab (ri-tuk-si-mab)
• G – gemcitabine (jem-site-uh-been)
• C – cyclophosphamide (sike-low-foss-fa-mide)
• V – vincristine (vin-kris-teen)
• P – prednisolone (pred-nis-oh-lone)

It is a treatment for non-Hodgkin lymphoma (NHL).

You might have R-GCVP if you have high grade B cell non Hodgkin lymphoma (NHL) and have heart problems and can’t have some types of chemotherapy, such as the combination R-CHOP.

How does R-GCVP work?

Rituximab is a type of targeted cancer drug called a monoclonal antibody . It targets a protein called CD20 on the surface of the cancer cells. Rituximab sticks to all the CD20 proteins it finds. Then the cells of the immune system pick out the marked cells and kill them.

Gemcitabine, cyclophosphamide and vincristine are types of chemotherapy drugs. These drugs destroy quickly dividing cells, such as cancer cells.

Prednisolone is a type of steroid. It treats the cancer by stopping the cancer cells growing and killing them. It may also help you feel less sick during treatment. And help reduce your body’s immune response, to try and prevent an allergic reaction to rituximab.

How do you have R-GCVP?

You take prednisolone as tablets. You swallow the tablets whole after a meal, or with milk, as they can irritate your stomach. It is best to take them after breakfast.   

You usually have all the other drugs into your bloodstream (intravenously).

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

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.

Risk of tissue damage

When you are having this treatment through a cannula it could damage the tissue if it leaks out of the vein. This is called extravasation. This can happen anywhere along the vein that the drug is going into. It doesn’t happen very often. Tell your nurse straight away if you notice any changes such as swelling, redness, pain, burning, or a stinging feeling.

Your nurse will stop the drug treatment. And they will treat the area to relieve symptoms and reduce tissue damage. Contact your healthcare team if you develop any of these symptoms when you are at home.

Taking you 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 R-GCVP?

You have R-GCVP as cycles of treatment. This means you have the drugs and then a rest to allow your body to recover.  

Each cycle of treatment lasts 21 days (3 weeks). You usually have 6 cycles of treatment.

Rituximab can cause an allergic reaction. So before each dose you have paracetamol, a steroid and an antihistamine drug such as chlorphenamine (Piriton).

For the first cycle of rituximab, you have it as a drip into your bloodstream slowly over a few hours. This is to prevent an allergic reaction. Your nurse will increase how fast it goes in (rate). This is approximately every 30 minutes if you have no allergic reaction.

Your next rituximab drip will usually go in quicker, but this will depend on how you got on with the first cycle.

You have R-GCVP in the following way:

You then start the next cycle of treatment.

You usually also have G-CSF. This is an injection under the skin (subcutaneous). It helps your body make white blood cells to lower your chance of getting an infection.

You have GCSF daily for 5 days from day 9 of your cycle.

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 treatment starts you have a blood test to check for viruses such as hepatitis B, hepatitis C, HIV or cytomegalovirus (CMV) . This is called a viral screen. You may not know if you have one or more of these viruses. But it is important for your doctor to know as this treatment can weaken your immune system .

What are the side effects of R-GCVP?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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

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: 

Increased 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 and looking pale

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).

Rarely your body might develop blood clotting problems for other reasons. Let your nurse or doctor know if you notice any bruising or are bleeding from anywhere.

Allergic reaction

A reaction may happen during the infusion. This can cause symptoms such as a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills.

Allergic reactions can sometimes be life threatening. Your nurse will give you medicines beforehand to try to prevent a reaction. 

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.

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. 

Blood or 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.

Inflammation of the bladder (cystitis)

You might feel that you have to pass urine more often than usual or find it difficult to pass urine. It may burn or sting when you do. Or you might feel that you can't wait when you need to go. This is called cystitis. 

It helps to drink plenty of fluids. Don't take any over the counter medicines for cystitis. Contact your advice line instead.

Tell your healthcare team if you have soreness. They can prescribe medicines to help.

Skin problems

Skin problems include a skin rash and itching. Less commonly you might get a raised itchy rash known as hives or urticaria.

Rarely this treatment can cause a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might have flu-like symptoms such as a fever and your eyes may be more sensitive to light. This is serious and could be life threatening.

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. 

Breathing problems

It is important to tell your doctor or nurse straight away if you have difficulty in breathing. It usually happens soon after having this treatment and is usually mild and will soon pass. But it could be for another reason. 

You might have inflammation, irritation or a feeling of tightness of the lungs, but these are less common. Rarer breathing problems include scarring of the lung tissue or swelling and narrowing of the air passages (tubes) in the lungs (asthma). 

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.

Liver changes

This treatment commonly causes liver changes that are usually mild which are picked up on blood tests.

Less commonly you might get yellowing of the skin and whites of the eyes. This is due to high levels of bilirubin in the blood.

In some severe cases some people get liver failure, but this is rare.

You have regular blood tests to check for any changes in the way your liver is working.

Flu like symptoms

This can happen a few hours after treatment. It may include headaches, muscle aches (myalgia), a high temperature and shivering. Taking paracetamol every 6 to 8 hours can help.

Swelling of different parts of the body

Swelling in the face, hands and feet. Rarely your tummy and lymph nodes  might swell. This usually goes away on its own but tell your doctor or nurse if you have it.

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

High temperature or chills

You might get a high temperature. Or you might feel cold or start shivering (chills). 

Pain in different parts of your body

This treatment can cause pain in different parts of your body such as the tummy (abdomen), muscle and bone. Occasionally you might have pain in the back, mouth, jaw, throat, chest, joints, neck and where the cancer is.

Let your treatment team know if you have this so that they can give you painkillers.

Decreased appetite and weight loss

You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Low levels of an antibody called immunoglobulin G in your body

Immunoglobulin G is an antibody made by the immune system to fight bacteria and viruses. You have regular blood tests during and after treatment to check for this. 

Occasional side effects

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

• a serious reaction to an infection (sepsis) - signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms
• high blood sugar levels – you might have to check them more often if you are diabetic
• indigestion symptoms include heartburn, bloating and burping
• mouth sores and ulcers
• mood changes such as feeling anxious and restless. Rarely people may get very low in mood (depressed) or feel very nervous
• sleeping problems - difficulty falling or staying sleeping (insomnia), difficulty staying awake (somnolence)
• feeling generally unwell (malaise)
• loose watery poo (diarrhoea)
• eye problems including an eye infection and inflammation (conjunctivitis) and making more tears
• blood pressure changes so it might go high or too low. Symptoms can include feeling  lightheaded, dizzy, headaches, confusion, vision problems or chest pain
• changes to the levels of minerals, salts and enzymes in the blood – you have regular blood tests to check this
• sweating more than usual or you may get drenching sweats at night
• changes to your hearing. You may have ringing in your ears or ear pain. You might have hearing loss but this is rare
• difficulty swallowing
• dizziness
• heart problems including changes to the heart rhythm or a heart attack. Rarely it can be it harder for the heart to pump blood to the rest of the body. Contact your healthcare team straight away if you feel tightness or pain in your chest, lightheaded, dizzy, sweating or anxious
• episodes of feeling warm and reddening of the skin (flushing)
• unusual feelings of the skin – such as numbness, tingling, pricking, burning, a creeping skin feeling or a reduced sense of touch
• runny nose
• a cough
• cold hands and feet
• getting stiff and difficulty moving due to the brain telling the muscles in your body to tighten (hypertonia)
• infections such as hepatitis B can become active again if you've had it in the past

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:

• a second cancer such as leukaemia
• changes in the way your kidneys work
• taste changes
• too little oxygen reaching the body’s organs
• confusion
• a condition where the bone marrow is unable to make all types of blood cells (aplastic anaemia)
• a condition where the red blood cells are destroyed faster than they can be made (haemolytic anaemia)
• a rare disorder of the nerves causing headaches, fits, confusion and changes in vision - contact your health team straight away. This condition is reversible
• fits (seizures)
• high levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this
• enlarged tummy (abdomen)
• swelling of the lymph nodes or glands
• several body parts (organs) might stop working
• high levels of fat (cholesterol) in the blood
• a stroke

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.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Women must not become pregnant for at least a year after the end of treatment. Men should not get someone pregnant for at least 6 months after treatment. 

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

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.    

Breastfeeding

Don’t breastfeed during this treatment and for 6 months after your last treatment. This is because the drug may come through into your breast milk.

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

For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug 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.