GemCarbo (gemcitabine and carboplatin)

GemCarbo is the name of a chemotherapy combination that includes:

• gemcitabine (pronounced jem-site-uh-been)
• carboplatin (pronounced car-bo-pla-tin)

It is a treatment for a number of different cancer types.

How does GemCarbo work?

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

How do you have GemCarbo?

You have both 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.

How often do you have GemCarbo?

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

Each cycle lasts 21 days (3 weeks). You might have up to 6 cycles of treatment, taking up to around 6 months in total depending on your cancer type.

You have each cycle of treatment in the following way:

You then start your next cycle of treatment.

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.

What are the side effects of GemCarbo?

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 getting an 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, bleeding gums or nosebleeds

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 commonly you might bleed from other areas of the body. Tell your medical team if you notice any bleeding.

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.

Flu-like symptoms

This may include headaches, muscle aches (myalgia), a high temperature and shivering. Ask your healthcare team if you can take medicines such as paracetamol to help.

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 have more serious liver problems needing treatment.

Fluid build up in your face, hands and feet 

Swelling can occur in the face, hands and feet. This usually goes away on its own but tell your doctor or nurse if you notice any swelling

Skin rash

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 if you have any of these symptoms. They can give you advice on what to do and what products you can use on your skin to help.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg 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. 

Tummy (abdominal) pain

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

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.

Kidney changes

You might have kidney 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 kidneys are working.

Rarely you might have more serious kidney problems needing treatment.

Difficulty breathing

You may have difficulty breathing after you have gemcitabine. This is usually mild and doesn’t need any treatment. 

More rarely you might have breathlessness, damage to the lungs or temporary narrowing of the bronchial tubes. This might cause wheezing or a cough.

Let your healthcare team know if you have any breathing problems. 

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:

• loss of appetite

• taste changes

• sore mouth and ulcers

• watery or loose poo (diarrhoea)

• constipation

• sleepiness - don't drive or use machinery if you have this

• difficulty falling asleep or staying asleep (insomnia)

• 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 have any of these symptoms

• numbness and tingling in your toes or fingers

• ringing in your ears or changes in your hearing

• headache

• temporary worsening of your eyesight, such as blurred vision or difficulty focusing

• pain or discomfort in your back, bones, joints, muscles, or surrounding structures such as the nerves and tendons

• tiredness and weakness (fatigue)

• inflammation of the lining of the nose

• heart problems such as a blockage in the artery. Less commonly you might develop heart rhythm changes, heart failure, or risk of a heart attack

• sweating

• high temperature or chills

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:

• leaking of fluid and proteins out of the blood vessels into the tissues (capillary leak syndrome)

• posterior reversible encephalopathy syndrome (PRES) - a rare disorder of the nerves causing headache, fits, confusion and changes in vision - contact your health team straight away. This condition is reversible

• redness or soreness at the drip site – let your nurse know straight away

• stroke

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

• gemcitabine
• carboplatin

Coping with side effects

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

What else do I need to know?

Other medicines, foods and drinks

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.

Contraception and pregnancy

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 6 months afterwards.

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

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

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.