1. What is gemcitabine?
Gemcitabine is a drug used to treat breast cancer.
2. Who might be offered gemcitabine?
You may be offered gemcitabine if you have:
- that cannot be removed by surgery - sometimes breast cancer is locally advanced when it’s first diagnosed, but it may also happen when breast cancer comes back after treatment for primary breast cancer (regional recurrence)
3. How is gemcitabine given?
Gemcitabine is usually given with another chemotherapy drug. This will either be paclitaxel (Taxol) or carboplatin.
Gemcitabine is given into a vein (intravenously). This will usually be as a drip, also called an infusion, into your hand or arm. It will take around 30 minutes.
You may have another intravenous method depending on how easy it is for the chemotherapy team to find suitable veins, and your preferences or individual situation.
Gemcitabine with paclitaxel (GemTaxol)
A cycle of gemcitabine with paclitaxel lasts 21 days.
On day 1 you’ll have gemcitabine and paclitaxel. On day 8 you’ll have gemcitabine only. This is followed by a rest period until the next cycle.
The total number of cycles you have will depend on your particular situation. Your treatment team will discuss this with you.
Gemcitabine with carboplatin (GemCarbo)
A cycle of gemcitabine with carboplatin lasts 21 days.
On day 1, you’ll have gemcitabine and carboplatin. On day 8, you’ll have gemcitabine only. This is followed by a rest period until the next cycle.
The total number of cycles you have will depend on your particular situation. Your treatment team will discuss this with you.
4. Before starting gemcitabine
Before starting your treatment, a member of the treatment team will discuss how and when you’ll have chemotherapy, what the side effects are and how these can be managed.
You’ll have blood tests and your height and weight will be measured.
You should be given a 24-hour contact number or told who to contact if you feel unwell at any time during your treatment, including at night or at the weekends.
5. Side effects of gemcitabine
Like any treatment, gemcitabine can cause side effects. Everyone reacts differently to drugs and some people have more side effects than others.
These side effects can usually be managed 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 worried about any side effects, regardless of whether they’re listed here, talk to your chemotherapy nurse or treatment team.
Common side effects of gemcitabine
Effects on the blood
Gemcitabine can temporarily affect the number of blood cells in the body. Blood is made up of red cells, white cells and platelets.
You’ll have regular blood tests to check your blood count.
If these show the number of blood cells is too low, your next cycle of treatment may be delayed or the dose of chemotherapy reduced.
Doctors often tailor the dose of a drug by reducing it to suit an individual and to help manage its side effects. For some people this can help them stay on a treatment for longer.
Risk of infection
Not having enough white blood cells can increase your risk of getting an infection.
Signs of an infection
Your treatment team may give you guidelines to follow for reporting signs of an infection. But generally you should contact your hospital immediately if you experience any of the following:
- A high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your treatment team has advised
- Suddenly feeling unwell, even with a normal temperature
- Symptoms of an infection, for example a sore throat, a cough, a need to pass urine frequently or feeling cold or shivery
Before starting chemotherapy you should be given a 24-hour contact number or told where to get emergency care by your treatment team.
You may need treatment for an infection.
Sometimes your doctor may recommend injections of drugs called growth factors. This helps the body produce more white blood cells to reduce your risk of infection.
Anaemia
Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your treatment team know.
Bruising and bleeding
Gemcitabine can reduce the number of platelets, which help the blood to clot.
You may also bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth.
Tell your treatment team if you have any of these symptoms.
Hair loss
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 other body hair.
Scalp cooling may prevent or reduce hair loss. Not all hospitals offer scalp cooling so ask your treatment team or chemotherapy nurse if this treatment is available and suitable for you.
Sore mouth
Looking after your mouth, including your teeth and gums, is very important during treatment.
You’ll be given mouthwash to try to reduce soreness and stop mouth ulcers developing.
See your dentist for a check-up before you start treatment. Avoid dental work during treatment if possible.
If you do need to have dental work during treatment, talk with your oncologist about the best time to have this.
Taste changes
Gemcitabine can make some food taste different (for example more salty, bitter or metallic). Taste usually returns to normal after you’ve finished treatment, although this may take some time.
Our information on diet during breast cancer includes tips on dealing with taste changes.
Feeling sick (nausea) and being sick (vomiting)
You may have nausea or vomiting while taking gemcitabine.
Your treatment team will give you anti-sickness medication before the chemotherapy is given. They will also prescribe anti-sickness drugs you can take home to reduce nausea or stop it happening.
If you still have nausea or vomiting, contact your treatment team. They may be able to change your prescription to a different anti-sickness drug for next time.
Extreme tiredness (cancer-related fatigue)
Cancer-related fatigue is 1 of the most common symptoms in people with secondary breast cancer.
Fatigue is extreme tiredness that does not go away with rest or sleep. It has many causes, from the emotional impact of a diagnosis to side effects of treatment or growth and spread of the cancer.
Fatigue may affect how you cope with your cancer and its treatment. It can also make everyday activities harder and affect your quality of life.
Find out more about managing fatigue.
Menopausal symptoms
Gemcitabine can cause menopausal symptoms if you have not already been through the menopause. This is because it affects the ovaries, which produce oestrogen.
Common menopausal symptoms can include:
- Hot flushes
- Night sweats
- Mood changes
- Joint aches and pains
- Vaginal dryness
You can talk to your breast care nurse or treatment team about ways of coping with any of these symptoms.
Skin reactions
You may develop rashes on your skin. These may itch. Your treatment team can prescribe medication to help with this.
Swelling (oedema)
You might have swelling (oedema) in your feet, hands and, extremely rarely, face. The swelling usually improves once treatment stops but tell your treatment team if it happens.
Flu-like symptoms
You may notice some flu-like symptoms while you’re having gemcitabine. Flu-like symptoms include:
- Headaches
- Runny nose
- Tiredness
- Aching bones and muscles
- Chills
If your temperature is high, let your treatment team know immediately as you may have an infection that needs treating.
Breathlessness and coughing
You may feel breathless. However, this is usually mild and should not need treatment. You may develop a cough. Let your treatment team know if you develop these symptoms.
Effect on the liver
Gemcitabine may affect how well your liver works. You’ll have regular blood tests to monitor this throughout your treatment.
Your liver function should return to normal soon after your treatment has stopped.
Let your treatment team know if you have had any liver problems in the past.
Effect on the kidneys
Gemcitabine can affect your kidneys. Your urine test may show an increase of protein or blood in your urine, but this is not likely to cause you any problems.
Less common side effects of gemcitabine
Diarrhoea or constipation
Contact your treatment team if you have diarrhoea 4 or more times in 24 hours.
Also let your treatment team know if you have constipation.
Loss of appetite
You may lose your appetite while having gemcitabine.
Talk to your treatment team about this. They can give you advice and information to help deal with loss of appetite, or refer you to a dietitian if needed.
Rare side effects
Allergic reaction
If you have an allergic reaction to gemcitabine, it will probably happen during the first few minutes of your first or second treatment. Reactions can vary from mild to severe, but severe reactions are uncommon.
Your treatment team will monitor you closely so they can deal with any reaction immediately.
Symptoms of an allergic reaction include:
- Flushing
- Skin rash
- Itching
- Back pain
- Lip or tongue swelling
- Shortness of breath
- Faintness
- 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.
Heart changes
Gemcitabine can affect the way your heart works, so it may not be suitable if you have an existing heart condition.
Heart problems because of gemcitabine are not common. However, your treatment team may arrange a heart (cardiac) function test before you start treatment to check your heart is working normally.
6. Other important information
Blood clots
People with breast cancer have a higher risk of blood clots such as a DVT (deep vein thrombosis).
If you have a DVT, there’s a risk part of the blood clot could break away and travel to the lung. This is known as a pulmonary embolism (PE).
Blood clots can be life-threatening and should be treated quickly.
Blood clot symptoms
Contact your treatment team or go to your local A&E department straight away if you have any of the following symptoms:
- Pain, redness/discolouration of the skin, heat and swelling of the arm or leg
- 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
- Pain or tightness in the chest
- Unexplained cough or coughing up blood
Find out more about blood clots.
Fertility
If you were diagnosed with locally advanced or secondary breast cancer before you started or completed a family, you may be concerned about your fertility (ability to get pregnant).
You can talk to your treatment team about options to preserve your fertility before starting treatment.
Sex, contraception and pregnancy
You can still have sex during treatment. It’s thought chemotherapy drugs cannot pass into vaginal fluids or semen, but this cannot be completely ruled out.
Most treatment teams will advise using barrier methods of contraception, such as condoms, during treatment and for a few days after chemotherapy is given.
You’re advised not to become pregnant while having treatment because gemcitabine can harm a developing baby. If you have not been through the menopause, talk to your team about the most suitable method of contraception for you. It’s still possible to become pregnant even if your periods are irregular or have stopped.
Vaccinations and travel
Travel vaccinations
If you’re planning a holiday or need to travel overseas, check with your treatment team first.
You should not have any live vaccines while you’re having chemotherapy.
Live vaccines include:
- Mumps
- Measles
- Rubella (German measles)
- Polio
- BCG (tuberculosis)
- Zostavax shingles vaccine
- 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 vaccinations 6 months after your treatment finishes. Talk to your GP or treatment team before having any vaccinations.
If anyone you have close contact with needs to have a live vaccine, speak to your treatment team or GP. They can advise what precautions you may need to take depending on the vaccination.
COVID-19 vaccination
If you’re having chemotherapy or targeted therapies, you’re advised to speak to your treatment team about the best time to have a COVID-19 vaccination.
Flu vaccination
Anyone at risk of a weakened immune system, and therefore more prone to infection, should have the flu vaccine. This includes people due to have, or already having, chemotherapy.
The flu vaccine is not a live vaccine so does not contain any active viruses.
Talk to your chemotherapy team or breast care nurse about the best time to have your flu jab.
Nasal flu vaccine for children
The nasal flu vaccine offered to children is a live vaccine. Let your treatment team know if someone you live with needs the nasal flu vaccine.
Driving and using machinery
Gemcitabine may make you feel sleepy. This could affect your ability to drive or operate machinery safely.
Avoid driving or using machinery until you’re sure gemcitabine does not make you feel sleepy.
7. Further support
On our online forum, you can find people going through treatment at the same time as you on the monthly chemotherapy threads.
