Gemcitabine + capecitabine (GemCap)

What this treatment is and how it works

GemCap combines gemcitabine infusion and capecitabine tablets. It is used in pancreatic cancer and selected other settings. Using medicines with different actions helps attack cancer cells in more than one way. Healthy cells can also be affected, causing side effects.

When it may be used

Your team may use this treatment in the following settings: Pancreatic and selected other cancers. The choice depends on the exact diagnosis, stage, previous treatment, health and treatment aim. Treatment may aim to cure cancer, lower the risk of recurrence, or control cancer and symptoms, depending on the setting.

A listed use is not a claim that every brand is licensed for that use in every country. Your oncologist will explain why this treatment is appropriate for you.

Before treatment

Before starting, tell the team about previous cancer treatment, allergies, infection symptoms, heart, lung, kidney or liver disease, hearing or nerve problems, diabetes and all medicines you take. Discuss pregnancy, contraception and fertility. Ask for a written treatment calendar, supportive-medicine instructions and a 24-hour oncology contact number. Baseline blood tests usually include a full blood count and kidney and liver function; additional tests depend on the medicine and your health. Before chemotherapy that reaches the whole body, the team should check for current or past hepatitis B infection. If a test is positive, extra monitoring or antiviral treatment may be needed to prevent the virus becoming active again. The team will coordinate testing and treatment; do not delay urgent cancer treatment yourself.

How treatment is given and the schedule

Anti-sickness medicines, a tablet calendar and a diarrhoea plan are provided. Pancreatic enzymes and dietetic support may be needed for digestive problems caused by the cancer or surgery.

The dose is calculated for your treatment and health. Rest periods, delays or dose changes may be needed. Do not change doses or treatment dates yourself, except to follow specific instructions to stop a medicine and seek help for warning symptoms. The team will give you a revised plan when needed.

During an infusion, tell the nurse immediately about pain, burning, swelling or leaking around the cannula or line. Do not massage the area or apply heat or ice unless the team instructs you.

Tests and monitoring during treatment

Before treatment, the team assesses dihydropyrimidine dehydrogenase (DPD), an enzyme that helps the body break down the fluorouracil made from capecitabine. Blood counts and kidney and liver tests are checked. The team reviews bowel symptoms, mouth soreness, hands and feet, weight and food intake.

At each review, describe symptoms since the previous dose, including problems that have already settled. Blood tests can detect effects before you feel them. Your team may delay, reduce, omit or stop a medicine if results or symptoms make this necessary. The decision depends on the exact protocol; a normal result does not make new symptoms safe to ignore.

Side effects: what to expect

Side-effect rates depend on the exact protocol, doses and other treatments. Frequencies from individual-drug labels cannot simply be added together or treated as regimen rates. The groups below describe the expected clinical pattern without assigning unsupported percentages.

You are unlikely to have all of these effects. This is not an exhaustive list. Tell the team about any new or troublesome symptom, including one not mentioned here.

Common or more frequent side effects

Other reported side effects (frequency varies)

These effects may be common in some treatment settings, less common in others, or have no reliable frequency estimate. Their position here does not mean they are necessarily less frequent or less serious.

Swelling, rash, flu-like symptoms, constipation and hair thinning can occur.

Report these at review, or sooner if worsening. Use the urgent guidance for symptoms that affect breathing, drinking, urination, walking, consciousness or bleeding.

Important serious side effects, including rare effects

Serious does not always mean rare. Where reliable incidence is unavailable, no numerical frequency is assigned. The action to take matters even when the likelihood is uncertain.

Unusually severe fluoropyrimidine toxicity

Reduced DPD activity can cause severe diarrhoea, mouth injury, low blood counts and neurological effects, sometimes early in the first course. Testing reduces but does not remove risk. Seek urgent oncology assessment for unexpectedly severe or rapidly worsening symptoms.

Chest pain or a heart-rhythm problem

New chest tightness, chest pain, severe breathlessness, fainting or a sustained racing heartbeat needs emergency assessment. Do not try to manage this with home remedies or wait for the next visit.

A rare blood-vessel and kidney complication

Thrombotic microangiopathy, including haemolytic uraemic syndrome, can damage blood cells and kidneys. New swelling, reduced urine, unusual bruising, marked tiredness or breathlessness needs urgent assessment and blood tests.

Inflammation or injury in the lungs

A new cough, breathlessness, chest discomfort or falling exercise tolerance needs urgent oncology contact. Severe or rapidly worsening breathing difficulty is an emergency. Infection and other causes must also be considered.

Suspected overdose or unexpectedly rapid infusion

If you may have taken extra capecitabine tablets, seek urgent medical assessment immediately, even if you feel well. Tell the oncology team what happened and when; bring the medicine packaging. A hospital may consider a time-sensitive antidote, so do not wait for symptoms or the next appointment. Local access to the antidote must be arranged by the treating service.

Practical advice for this treatment

Take capecitabine within 30 minutes after food, following your written tablet calendar. Do not confuse this 21-day tablet phase with the 14-day phase used in some other regimens.

Stop capecitabine and contact the oncology team immediately if you have any of the following:

• Four or more extra bowel movements in a day, compared with your usual pattern, or diarrhoea at night.
• Vomiting more than once in 24 hours, or eating much less than usual because of nausea.
• Pain, redness, swelling or sores in your mouth or throat.
• Pain, redness, swelling or tingling in your palms or soles.
• Fever or signs of infection. Follow your hospital’s temperature instructions and the urgent-help advice above.

If chest pain develops, stop capecitabine and seek emergency medical assessment. Do not restart capecitabine until the oncology team tells you it is safe and confirms your dose.

Taking cancer medicines at home

Keep cancer tablets or capsules in their labelled packaging, away from children and pets. Do not share them or put them in a household pill organiser unless the oncology pharmacist agrees. Do not crush, open, split or dissolve them without product-specific pharmacy instructions. A caregiver who handles the medicine should follow the pharmacy’s precautions. Return unused medicine to the pharmacy. If you miss a dose or vomit after one, do not take an extra dose; contact the team and follow the medicine-specific plan. If you accidentally take an extra dose or the wrong strength, contact the oncology team urgently even if you feel well. Do not try to make yourself vomit or work out a compensating dose yourself.

Medicines, interactions and vaccinations

Give the oncology pharmacist a complete list of prescription medicines, over-the-counter products, vitamins, herbal and Ayurvedic remedies and supplements. Ask before starting anything new. Do not stop prescribed medicines, including anticoagulants or infection-prevention medicines, without a coordinated plan. Live vaccines are generally unsuitable while immunity is suppressed; discuss vaccine type and timing with the team. Non-live vaccines may be offered, although protection can be reduced. Follow any specific stop-and-call instructions for the cancer medicine on this page or in your written treatment plan.

• Gemcitabine: Radiotherapy timing matters because gemcitabine can increase radiation-related injury. Other medicines that suppress blood counts or affect kidney function need review.
• Capecitabine: Brivudine must not overlap with capecitabine; at least 4 weeks are needed after brivudine before starting capecitabine. Warfarin can cause dangerous bleeding unless closely monitored. Phenytoin, allopurinol and other medicines need a pharmacist check.

Pregnancy, fertility and breastfeeding

Chemotherapy can harm a developing baby and may affect fertility temporarily or permanently. Discuss sperm, egg or embryo storage before treatment when feasible. If you could become pregnant, or your partner could become pregnant, use effective contraception during treatment and for the drug-specific period afterwards. Ask for a written end date based on every medicine in your plan: the required period differs by product and can extend for months. Periods stopping does not guarantee infertility. Tell the team immediately about a suspected pregnancy. Do not breastfeed during treatment; restart only after the team confirms the interval for the exact medicine and formulation.

Everyday life

Gentle activity, regular meals and rest can help you cope. Prepare food hygienically and drink according to your individual fluid plan. Avoid smoking; ask whether alcohol is safe with your exact treatment and other medicines. Plan work, travel and driving around symptoms and monitoring visits. Do not drive if dizzy, sleepy, weak, visually affected or impaired by neuropathy. You can usually be close to family and friends: chemotherapy does not make you radioactive. Follow the unit’s instructions for handling urine, vomit, laundry and sexual precautions for the period it specifies.

When to contact the oncology team

Contact the oncology team the same day for persistent vomiting or diarrhoea, difficulty drinking, reduced urine, mouth pain affecting eating, new cough, jaundice, a painful or spreading rash, unusual bruising, worsening constipation or new nerve symptoms. Use the more urgent instructions for the particular symptom when given above. If the team cannot be reached and you are unwell, seek urgent medical care.

Write down your hospital’s daytime and out-of-hours numbers before treatment. CTI’s general contact details do not replace the emergency number provided by your treating hospital.

After treatment

Keep the planned blood tests and follow-up appointments after the last dose. Blood counts and immunity may take time to recover, and some effects can start or persist later. Contact the team about symptoms rather than waiting for a routine visit. Keep a treatment summary, including drug names, dates and any serious reactions, for future doctors. Response may be assessed with examination, scans or blood or marrow tests, depending on the cancer.

Words you may hear

DPD / DPYD

DPD is an enzyme that helps break down fluorouracil. DPYD is the gene that carries its instructions. Reduced activity can increase serious toxicity.

Frequently asked questions

Individual medicine guides

• Gemcitabine
• Capecitabine