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Gemcitabine and capecitabine (GemCap)

GemCap is the name of a chemotherapy combination that includes: 

  • gemcitabine
  • capecitabine

It is a treatment for pancreatic cancer.

How it works

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

How you have GemCap

You have gemcitabine as a drip into your bloodstream (intravenously). 

Capecitabine is a tablet you take twice a day, after food. You swallow the tablets with water within 30 minutes of finishing a meal.

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 each time you have treatment.

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have GemCap

You usually have GemCap chemotherapy in cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover. Each cycle lasts 28 days (4 weeks).

You may have GemCap for up to 6 treatment cycles. Or you have it for as long as it is working, and the side effects aren’t too bad.  

How long you have it for will depend on your situation. Your healthcare team will tell you more about this. 

You have each cycle of treatment in the following way: 

Day 1
  • You have gemcitabine as a drip into your bloodstream over 30 minutes.
  • You take capecitabine tablets twice a day.
Day 2 to 7
  • You take capecitabine tablets twice a day.
Day 8
  • You have gemcitabine as a drip into your bloodstream over 30 minutes.
  • You take capecitabine tablets twice a day.
Day 9 to 14
  • You take capecitabine tablets twice a day.
Day 15
  • You have gemcitabine as a drip into your bloodstream over 30 minutes.
  • You take capecitabine tablets twice a day.
Day 16 to 21
  • You take capecitabine tablets twice a day.
Day 22 to 28
  • You have no treatment.

You then start the next treatment cycle. 

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.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely 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. 

Contact your advice line or your doctor or nurse immediately if you have signs of infection, such as a temperature above 37.5C or below 36C, or if you develop a severe skin reaction. Signs of a severe skin reaction include peeling or blistering of the skin.

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:

Risk of 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

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising and bleeding

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 often you might have bleeding from other areas of the body. Let your doctor or nurse know if this happens.

Tiredness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

You might also feel weak or lacking energy. This is called asthenia.

Flu like symptoms

This can happen a few hours after treatment. It may include headaches, muscle aches (myalgia), a high temperature and shivering. Talk to your nurse about this. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all 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 treating it once it has started.

Soreness, redness, and peeling on palms and soles of the feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your doctor or nurse will tell you what moisturiser to use.

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Diarrhoea can be severe, but it's usually well controlled with medicines. 

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 get yellowing of the skin or whites of the eyes (jaundice).  

Blood in urine

This is called haematuria. You might have regular urine tests to check for this. Talk to your team if you see blood in your urine.

Fluid build up 

A build up of fluid may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your doctor if this happens to you.

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Tummy (abdominal) pain

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

Sore mouth and ulcers 

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

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. 

Skin problems

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 straight away. They can give you advice on what to do and what products you can use on your skin to help.

Difficulty breathing 

You may have shortness of breath with wheezing and coughing. This could be the cause of different lung problems. Let your doctor or nurse know straight away if this happens. 

Numbness or tingling in fingers or toes 

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Nail problems 

Your nails might break more easily, or slightly change colour.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and10%). You might have one or more of them. They include:

  • constipation
  • drowsiness
  • headaches and dizziness
  • eye problems such as infections and increased production of tears. Rarely, you may get eye pain, blurred or double vision. Let your team know if this happens
  • difficulty sleeping (insomnia)
  • ringing in the ears (tinnitus)
  • hiccups
  • runny nose
  • heartburn or indigestion
  • wind
  • dry mouth
  • pain in your chest, joints, back. arms or legs. Rarely, you might have pain in your bones or face. Let your team know if this happens.
  • generally feeling unwell (malaise)

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:

  • blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
  • heart problems such as changes to your heart rhythm, pounding or fluttering feeling (palpitations) or heart attack
  • non cancerous (benign) lumps under the skin (lipoma)
  • 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 notice any of these symptoms
  • changes to the level of substances in the blood such as high levels of fats in the blood (triglycerides) and sugar levels (diabetes). Or you might have low levels of potassium.
  • mood and behavioural changes such as confusion, panic attacks, feeling low and loss of interest in sex (libido)
  • nerve problems such as difficulty speaking, uncoordinated body movements so you might find it difficult to walk and have poor balance, and memory changes
  • passing out (fainting)
  • inflammation of the digestive system
  • swelling and stiffness of the joints
  • muscle stiffness and weakness
  • hot flushes
  • kidney problems such as passing lots of urine at night, leaking urine (incontinence) – you will have regular blood tests to check for this

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?

Low levels of DPD

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Low DPD levels don’t cause symptoms so you won’t know if you have a deficiency. You should have a test before you start this treatment to check if you have a DPD deficiency. 

Some people have severe side effects from capecitabine or fluorouracil even if they don't have low DPD levels. Contact your doctor or nurse if your side effects are severe.

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Lactose intolerance

Capecitabine contains lactose (milk sugar). If you have an intolerance to lactose, contact your doctor before taking this medicine.

Sodium

Gemcitabine contains sodium. If you have a sodium restricted diet, contact your doctor before taking this medicine.

Loss of fertility

You may not be able to become pregnant or father a child 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.    

Contraception and pregnancy

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

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

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

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 the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

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.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. 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 about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
29 Dec 2020
Next review due: 
29 Dec 2023
  • Electronic Medicines Compendium 
    Accessed August 2020

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • Consensus report of the International Society of Gastrointestinal Oncology on therapeutic progress in advanced pancreatic cancer
    H. Hochster and others
    Cancer, 2006. Vol. 107, Issue 4, Pages 676-685

  • Gemcitabine – Capecitabine for Palliative Pancreatic Cancer
    South East London NHS Cancer Network, accessed 2018

  • Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial​
    J Neoptolemos and others
    The Lancet, 2017. Vol. 389, Pages 1011-1024​​

  • Capecitabine plus oxaliplatin (CapOx) versus capecitabine plus gemcitabine (CapGem) versus gemcitabine plus oxaliplatin (mGemOx): final results of a multicenter randomized phase II trial in advanced pancreatic cancer 
    S Boeck and others
    Annals of Oncology, ​2008. Vol. 19, Issue 2, Pages 340-347