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GemCarbo (gemcitabine and carboplatin)

GemCarbo is the name of a chemotherapy combination that includes the drugs:

  • Gem – Gemcitabine
  • Carbo – Carboplatin

GemCarbo is a treatment for:

  • non small cell lung cancer
  • bladder cancer
  • advanced breast cancer
  • ovarian cancer

How it works

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

How you have GemCarbo

You have both drugs into your bloodstream.

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

When you have GemCarbo

You usually have chemotherapy as cycles of treatment. Each GemCarbo treatment cycle takes 3 weeks. A usual course of treatment consists of 4 to 6 cycles, taking 3 to 4 months.

On the first day of the cycle you have gemcitabine and carboplatin. A week later you have gemcitabine only. You then have a two week break with no treatment before starting another 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's 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 treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist 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 doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

Each of these effects happens in more than 1 in 10 people (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.

You might also be short of breath due to problems with your lungs.

Bruising, bleeding gums or nosebleed

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 petechia).

Tiredness and weakness (fatigue) during and after treatment

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.

High temperature

You might get a high temperature (fever) for a few hours after having this treatment. Tell your doctor or nurse if you have a fever.

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.

Flu like symptoms

This can happen a few hours after treatment. It may include headaches, muscle aches (myalgia), a high temperature and shivering. Taking paracetamol every 6 to 8 hours can 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.

Kidney changes

You might have some changes in the way your kidneys work. You'll have regular blood tests to check how well they are working.

Swelling

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

A rash can also be itchy. Tell your doctor or nurse if you have a skin rash. They can prescribe medicine to stop the itching and soothe your skin.

Hair loss

Your hair may thin. This is usually not noticeable by other people but can be upsetting. It usually begins thinning out gradually within 3 to 4 weeks after you start taking the drug. 

Blood in urine

Small amounts of blood and protein in your urine may be found when your nurse tests your urine. This is not harmful.

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:

  • loss of appetite - usually returns to normal after treatment is finished
  • taste changes - your taste goes back to normal after treatment is finished
  • diarrhoea - your doctor they might be able to give you some medicine to help
  • constipation - tell your doctor if it goes on for more than 3 days
  • sore mouth and ulcers - a sore mouth can start a few days after treatment, usually clears up 3 to 4 weeks after treatment ends
  • wheeziness and breathlessness - can happen soon after treatment, tell your doctor or nurse if it is severe
  • sleepiness - don't drive or use machinery after your treatment
  • allergic reaction - can happen after the first or second treatment tell your nurse or doctor immediately if you feel itchy, short of breath, develop a rash or anything else
  • numbness and tingling in your toes or fingers - starts within a few days or weeks, can last for a few months but rarely permanent.
  • ringing in your ears (tinnitus) - often gets better after treatment is finished
  • hearing problems - you might not be able to hear high tones after treatment is finished
  • headache
  • problems with your eyesight
  • muscle pain

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). There are 2 rare side effects that your doctor should know about as soon as possible:

  • capillary leak syndrome - symptoms are overall swelling, shortness of breath, low blood pressure and weight gain
  • posterior reversible encephalopathy syndrome - symptoms are headaches with confusion, feeling tired and weak (lethargy), fits (seizures) and vision changes

Contact your treatment advice line as soon as you can.

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 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.

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

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

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.

Information and help