1. What is gemcitabine?
2. Who might be offered gemcitabine?
3. How gemcitabine is given
4. Common side effects of gemcitabine
5. Less common side effects of gemcitabine
6. Rare side effects
7. Contraception during treatment
9. Allergic reaction and blood clots
Gemcitabine is a chemotherapy drug used to treat breast cancer. It’s also known by the brand name Gemzar.
Gemcitabine is used to treat people who have:
- locally advanced breast cancer (breast cancer that has spread to the tissues and lymph nodes around the chest, neck and under the breastbone) when surgery is not possible
- secondary breast cancer (breast cancer that has spread to other parts of the body), also known as advanced or metastatic breast cancer
Gemcitabine is given as a drip into a vein (intravenously) in the hand or arm, although there are other ways of giving it depending on factors such as how easy it is for chemotherapy staff to find suitable veins and your preferences. Read about the different ways chemotherapy may be given.
Chemotherapy is most commonly given as a series of treatments with a break between each treatment to give your body time to recover from any short-term side effects. The treatment and period of time before the next one starts is known as a cycle.
A cycle of gemcitabine, with either carboplatin or paclitaxel, lasts 21 days, with treatment given on days one and eight of the cycle.
The total number of cycles will depend on your particular situation. Your specialist will discuss this with you.
Like any treatment, gemcitabine chemotherapy can cause side effects. Everyone reacts differently to drugs and some people have more side effects than others. Side effects can usually be controlled and those described here will not affect everyone. If you’re being given other chemotherapy or anti-cancer drugs with gemcitabine, you may also have side effects from those drugs.
If you’re concerned about any side effects, whether they’re listed here or not, talk to your chemotherapy nurse or cancer specialist (oncologist).
Effects on the blood
Gemcitabine can temporarily affect the number of healthy blood cells in the body.
You’ll have regular blood tests to check your blood count. If the number of blood cells is too low, your next course of treatment may be delayed or the dose of chemotherapy reduced.
Not having enough white blood cells can increase the risk of getting an infection.
Contact your hospital immediately if:
- you have a high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your chemotherapy team has advised
- you suddenly feel unwell, even with a normal temperature
- you have any symptoms of an infection, for example, a sore throat, a cough, a need to pass urine frequently or feel cold and/or shivery
You may also bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth. Tell your specialist team if you have any of these symptoms.
Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your specialist team know.
Hair loss (alopecia)
On its own, gemcitabine can cause hair thinning. However, when it’s given with carboplatin or paclitaxel, most people will lose all their hair, including eyebrows, eyelashes and body hair. Hair loss should be temporary and in most cases your hair will begin to grow back a few weeks after your treatment has ended.
Sore mouth and taste changes
You’ll be given mouthwash to try to reduce soreness of the mouth and gums and stop mouth ulcers developing. Good mouth hygiene is very important during treatment. It’s advisable to see your dentist for a check-up before chemotherapy begins, but avoid dental treatment during chemotherapy.
While you're having gemcitabine your taste can change and some food may taste different (for example more salty, bitter or metallic). This usually returns to normal once you have finished treatment.
Nausea and vomiting
You may experience nausea (feeling sick) and vomiting (being sick), but many people will not actually be sick. You’ll be given anti-sickness medication into your vein before the chemotherapy is given, and you’ll be prescribed anti-sickness drugs to take home to reduce nausea or stop it happening.
It’s common to feel extremely tired during your treatment. For some people, fatigue can last for several weeks or even months after the treatment has finished, but your energy levels will gradually return.
Find out more about different ways of coping with and managing fatigue.
Effects on fertility
Chemotherapy can affect fertility – causing periods to stop temporarily or permanently. If you’re concerned about this, talk to you specialist team.
Sometimes gemcitabine can cause women who haven’t been through the menopause to experience menopausal symptoms. This is because it affects their ovaries, which produce oestrogen.
Common symptoms can include:
- hot flushes and night sweats
- mood changes
- joint aches and pains
- vaginal dryness
Sore eyes and runny nose
Gemcitabine can cause soreness and a gritty feeling in your eyes, or your eyes may water. Eye drops can be prescribed to relieve the soreness. Gemcitabine can also cause a runny nose.
Skin rashes can develop, which may itch. Your doctor can prescribe treatment to help with this. Occasionally swelling (oedema) can occur in the feet, hands and (extremely rarely) face. The swelling usually improves once treatment stops but tell your specialist team if it happens.
You may notice symptoms such as headaches, tiredness, aching bones and muscles or chills. If your temperature is high, let your specialist team know immediately as you may have an infection that needs treating.
Breathlessness may occur but it’s usually mild and should not need treatment. Some people may develop a cough.
Effect on the liver
Gemcitabine may affect how well your liver works. You’ll have regular blood tests to monitor this throughout your treatment. This is a temporary effect and the liver will return to normal soon after your treatment has stopped. However, it’s important to let your specialist team know if you have had any liver problems in the past caused by hepatitis or excess alcohol use.
Effect on the kidneys
Occasionally urine tests can show an increase of protein or blood in the urine, but this is not likely to cause you any problems.
Diarrhoea or constipation
You may have mild diarrhoea. However, contact your specialist chemotherapy team if you have four or more episodes of diarrhoea within a 24-hour period.
Alternatively, you may have constipation. Drinking plenty of water and eating a high-fibre diet can help reduce constipation. If you’re constipated for more than two to three days, your specialist or GP can prescribe medication to help.
Loss of appetite
You may lose your appetite while having gemcitabine. Talk to your specialist about this. They can give you advice and information to help deal with loss of appetite, or refer you to a dietitian if needed.
Driving and using machinery
Gemcitabine may make you feel sleepy, so could possibly affect your ability to drive or operate machinery safely. Avoid driving or using machinery until you are sure gemcitabine doesn’t make you feel sleepy.
Although rare, some people have heart problems with gemcitabine such as changes in blood pressure or heart rate and rhythm. It’s important to let your specialist team know if you have an existing heart condition.
Having gemcitabine when pregnant may have a harmful effect on a developing baby. Some women can still become pregnant even if their periods are irregular or have stopped, so use effective barrier contraception such as a condom.
You shouldn’t have any live vaccines while you’re having chemotherapy. Live vaccines include measles, rubella (German measles), polio, BCG (tuberculosis), shingles and yellow fever.
Live vaccines contain a small amount of live virus or bacteria. If you have a weakened immune system, which you may do during chemotherapy, they could be harmful.
It’s safe to have these vaccines six months after your chemotherapy finishes. Talk to your GP or specialist before having any vaccinations.
If someone you live with needs to have a live vaccine speak to your specialist or GP. They can advise what precautions you may need to take depending on the vaccination.
Anyone at risk of a weakened immune system should have the flu vaccine. This includes people due to have or already having chemotherapy. The flu vaccine is not a live vaccine so doesn’t contain any active viruses. If you’re already having chemotherapy, talk to your chemotherapy specialist or breast care nurse about the best time to have your flu jab.
If you have an allergic reaction to gemcitabine, it will probably happen within the first few minutes of your treatment and is most likely the first or second time you have the drug. Reactions can vary from mild to severe, but severe reactions are uncommon.
You’ll be monitored closely so that any reaction can be dealt with immediately.
Symptoms of an allergic reaction include:
- skin rash
- back pain
- shortness of breath
- fever or chills
If you have a severe reaction, treatment will be stopped immediately.
Medication can be given before future treatments to reduce the risk of further reactions.
People with breast cancer have a higher risk of blood clots. Their risk is higher because of the cancer itself and some treatments for breast cancer. Having gemcitabine increases the risk of blood clots such as deep vein thrombosis (DVT). People with a DVT are at risk of developing a pulmonary embolism. This is when part of the blood clot breaks away and travels to the lung.
If the cancer has spread to other parts of the body (secondary breast cancer), this also increases the risk.
Blood clots can be harmful but are treatable so it’s important to report symptoms as soon as possible.
If you experience any of the following symptoms contact your local A&E department, GP or specialist team straight away:
- pain, redness/discolouration, heat and swelling of the calf, leg or thigh
- swelling, redness or tenderness where a central line is inserted to give chemotherapy, for example in the arm, chest area or up into the neck
- shortness of breath
- tightness in the chest
- unexplained cough (may cough up blood)