This page tells you about the cancer drug combination R-GCVP and its possible side effects. There are sections about
R-GCVP is the name of a combination of cancer drugs used to treat high grade B cell non Hodgkin lymphoma (NHL). It is used for people who have heart problems and can’t have some other types of chemotherapy drugs.
R-GCVP is made up of the drugs
- Rituximab (pronounced rit-ux-i-mab) – a type of biological therapy
- Gemcitabine chemotherapy (pronounced jem-sigh-tah-been)
- Cyclophosphamide chemotherapy (pronounced sigh-clo-fos-fah-mide)
- Vincristine chemotherapy (pronounced vin-cris-teen)
- Prednisolone – a type of steroid
You have prednisolone as tablets. It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.
You have the other drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath or PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. The tube stays in place as long as you need it.
You usually have chemotherapy as cycles of treatment. You have between 6 and 8 cycles.
Each cycle of treatment lasts 3 weeks and is given in the following way.
On the first day you have
- Rituximab as a drip (infusion) – the first time it lasts about 4 hours but after that it usually takes 90 minutes
- Gemcitabine as a drip for about 30 minutes
- Vincristine as a short drip
- Cyclophosphamide as an injection into your cannula or central line or as a drip over 30 minutes
- You start taking prednisolone as tablets. You take it for 5 days. After the first dose you take the rest at home. You need to swallow the tablets whole after a meal, or with milk, as they can irritate your stomach. It is best to take them after breakfast. Your doctor will advise you which dose you need to take.
One week later you have gemcitabine as a drip for 30 minutes.
Then you have no treatment for 2 weeks.
You then start the next cycle of treatment.
Some people have an allergic reaction to rituximab. So your first dose is given slowly over about 4 hours. To help prevent a reaction you will have paracetamol and a drug called chlorphenamine (Piriton).
The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change how bad they are. The side effects of R-GCVP are listed below. You can use the links to find out more about each side effect. For general information, see our side effects of cancer drugs section.
More than 10 in every 100 people have 1 or more of the side effects listed below.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. Your doctor will check your blood cell levels regularly
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
- A reaction to rituximab while the drug is being given, causing flu like symptoms such as a high temperature (fever), chills and shivering (rigors), a headache and feeling sick. Your nurse will give you medicines beforehand to try to prevent a reaction. If you have a reaction, your nurse will slow your drip down or stop it for a while
- Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- Drowsiness for a few hours after treatment due to the presence of alcohol in gemcitabine – drinking alcohol may make the drowsiness worse. Don't drive or operate machinery while you feel drowsy
- Feeling or being sick is usually well controlled with anti sickness medicines
- Numbness or tingling in fingers and toes can cause difficulty with small things such as doing up buttons. This starts a few days or weeks after treatment. It usually goes within a few months of treatment ending
- Constipation, sometimes with stomach cramps – this can usually be prevented with regular laxatives. Drink 6 to 8 glasses of water or other liquids a day. If you are constipated for more than 3 days, tell your doctor or nurse
- Loss of appetite
- Hair thinning – this usually happens about 3 to 4 weeks after your first dose. The hair will grow back after treatment
- A sore mouth
- Small amounts of blood and protein in your urine – this may show on urine tests but is not harmful
- Your skin may darken or you may have a rash that may itch
- Women may stop having periods (amenorrhoea) – this may be temporary
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. It is important to talk to your doctor before starting treatment if you want to have a baby in the future. Men may be able to store sperm before starting treatment
- Night sweats
- A runny nose (rhinitis) may occur but is usually mild. It goes away within an hour of the infusion
- Indigestion, and stomach pains or discomfort
- A change in blood sugar levels – tell your nurse or doctor if you get very thirsty or if you are passing urine more than usual
- A mild effect on the liver that is unlikely to cause any symptoms – it will almost certainly go back to normal when the treatment ends. You will have regular blood tests to check it
- A high temperature (above 38°C) about 6 to 12 hours after treatment – paracetamol 6 to 8 hourly should help
Some people may have one or more of the following side effects
- Flushing occurs in about 1 in 20 people (5%) – when you are having rituximab you may have a sudden warm feeling and your face may go red
- About 1 in 20 people (5%) have a severe allergic reaction to rituximab, with wheezing, an itchy rash and a drop in blood pressure. Tell your nurse straight away if you have wheezing, a rash, or feel dizzy and faint
- Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your nurse straight away
- Vincristine can affect the bladder nerves, causing temporary urine leakage (incontinence)
- Temporary taste changes
- Jaw pain, caused by vincristine affecting your nerves
- Diarrhoea is usually mild, but drink plenty of fluids – if it becomes severe or continues let your doctor or nurse know
- Your nails may darken or become ridged, brittle or chipped
- Swelling in your face, hands and feet – this usually goes away on its own, but tell your doctor or nurse if you have it
- Wheezing or breathlessness
- Cyclophosphamide can cause cystitis (inflammation of the bladder lining), pain and occasionally blood in the urine. You need to drink 1 to 2 pints of fluid a day. You may have extra fluids through your cannula or central line too. If you see blood in your urine, contact your doctor or nurse straight away
Fewer than 1 in 100 people (1%) have 1 or more of the following side effects
- A second cancer some years after R-GCVP treatment
- Lung changes that may lead to a cough or breathlessness
- Kidney changes – you will have regular blood tests to check how well your kidneys are working
- Fluid build up may cause swelling in the legs and feet
- Bone pain
- Blurred or double vision
- Hearing loss or dizziness
- Hallucinations (seeing or hearing things that are not there)
- Trouble sleeping
You may get 1 or 2 or a few of the side effects mentioned on this page. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on
- How many times you've had a drug before
- Your general health
- How much of the drug you have (the dose)
- The way you have the drug
- Other drugs you are having
Coping with side effects
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Do not breastfeed during this treatment because the drug may come through in the breast milk.
You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad
We don’t list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk and look up each drug.
If you have a side effect we don’t mention here and you think it may be due to this treatment, you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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