R-GCVP

R-GCVP is the name of a cancer drug combination that includes rituximab, gemcitabine, cyclophosphamide, vincristine and prednisolone. It is a treatment for non-Hodgkin lymphoma (NHL).

What is R-GCVP?

R-GCVP is the name of a cancer drug combination that includes:

  • R - rituximab
  • G - gemcitabine
  • C - cyclophosphamide
  • V - vincristine
  • P - prednisolone

It is a treatment for high grade B cell non Hodgkin lymphoma (NHL). It is used for people who have heart problems and can’t have some types of chemotherapy, such as the combination R-CHOP.

How does R-GCVP work?

Rituximab is a type of targeted cancer drug called a monoclonal antibody Open a glossary item. It targets a protein called CD20 on the surface of the lymphoma cells. Rituximab sticks to all the CD20 proteins it finds. Then the cells of the immune system pick out the marked cells and kill them.

Gemcitabine, cyclophosphamide and vincristine are types of chemotherapy drugs. These drugs destroy quickly dividing cells, such as cancer cells.

Prednisolone is a type of steroid. It treats lymphoma by stopping the cancer cells growing and killing them. It may also help you feel less sick during treatment. And help reduce your body’s immune response, to try and prevent an allergic reaction to rituximab.

How you have R-GCVP?

You take prednisolone as tablets. You swallow the tablets whole after a meal, or with milk, as they can irritate your stomach. It is best to take them after breakfast.   

You usually have all the other drugs into your bloodstream (intravenously).

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 you 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.

How often do you have R-GCVP?

You have R-GCVP as cycles of treatment. This means you have the drugs and then a rest to allow your body to recover.  You usually have 6 cycles of treatment.

Each cycle of treatment lasts 21 days (3 weeks).

You have R-GCVP in the following way:

Day 1
  • You take prednisolone tablets once a day in the morning with or after food.
  • You have rituximab as a drip (infusion) into your bloodstream.
  • You have gemcitabine as a drip into your bloodstream for about 30 minutes.
  • You have vincristine as a short drip into your bloodstream over10 minutes.
  • You have cyclophosphamide as a short drip into your bloodstream over 10 minutes.
Days 2 to 5
  • You take prednisolone tablets once a day in the morning with or after food.
Day 6 to 7
  • You have no treatment.
Day 8
  • You have gemcitabine as a drip into your bloodstream for about 30 minutes.
Day 9 to day 21
  • You have no treatment.

You then start the next cycle of treatment.

Infusion related reaction to rituximab

Some people can have an allergic reaction to rituximab. So the first time you have it very slowly over about 4 hours. This helps to prevent a reaction. Your nurse will give you paracetamol and another drug called chlorphenamine (Piriton) about 30 minutes before you start. 

If you start to have a reaction your nurse will stop the infusion. They start it again once your symptoms have got better and it is safe to do so. If you don't have a reaction, you should be able to have your next rituximab infusion at a faster rate (over about 90 minutes).

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 R-GCVP?

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.

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 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 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).

Rarely your body might develop blood clotting problems for other reasons. Let your nurse or doctor know if you notice any bruising or are bleeding from anywhere.

Allergic reaction

A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills.

Allergic reactions can sometimes be life threatening. Your nurse will give you medicines beforehand to try to prevent a reaction. Tell your nurse or doctor immediately if at any time you feel unwell. They will slow or stop your drip for a while.

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.

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.

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. 

Blood or 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.

Inflammation of the bladder (cystitis)

You might feel that you have to pass urine more often than usual or find it difficult to pass urine. And you may have a burning feeling when you do. Or you might feel that you can't wait when you need to go. This is called cystitis. 

It helps to drink plenty of fluids. Some people think that cranberry juice can help but others feel it makes the soreness worse.

You might find that some drinks increase the soreness, such as tea and coffee. You can experiment for yourself and see what works for you.

Don't take any over the counter medicines for cystitis as they could be harmful.

Tell your doctor or nurse if you have soreness. They can prescribe medicines to help.

Skin problems

Skin problems include:

  • a rash, some rashes can be severe, and your skin might tighten due to an allergic reaction
  • itching or an urge to scratch
  • thinner areas of skin
  • wounds not healing properly

Less commonly you might get a raised itchy rash known as hives or urticaria.

Let your nurse or doctor know if you have any of the above symptoms. Especially if they come on quickly.

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. 

Breathing problems

It is important to tell your doctor or nurse straight away if you have difficulty in breathing. It usually happens soon after having this treatment and is usually mild and will soon pass. But it could be for another reason. 

Less commonly you might have inflammation and irritation of the lungs. Rarer breathing problems include swelling and narrowing of the air passages (tubes) in the lungs (asthma). 

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.

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.

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.

Swelling of different parts of the body

Swelling in the face, hands and feet. Rarely your tummy and lymph nodes Open a glossary item might swell. This usually goes away on its own but tell your doctor or nurse if you have it.

Headaches

Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

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:

  • indigestion symptoms include heartburn, bloating and burping
  • mouth sores and ulcers
  • mood changes such as feeling anxious and restless. Rarely people may get very low in mood (depressed), nervous or a feeling lots of energy (mania)
  • difficulty sleeping
  • low levels of certain hormones in the body
  • feeling generally unwell (malaise)
  • loose watery poo (diarrhoea)
  • loss of appetite
  • eye problems such as clouding of the lens of the eye (cataracts), damage to the nerve that connects to the eye to the brain (glaucoma), eye infection and inflammation such as conjunctivitis and making more tears or problems with your tear ducts
  • blood pressure changes it might go high or too low
  • weakening of the bones, increasing the risk of breaking bones (osteoporosis)
  • muscle problems such as muscle wasting this might cause your legs to feel weak and you might find it more difficult to walk and climb stairs. Or your muscle might feel tight which makes your legs and arms stiff and difficult to move.
  • changes to the levels of minerals, salts and enzymes in the blood – you have regular blood tests to check this
  • weight loss which can be sudden and severe
  • sweating more than usual or you may get drenching sweats at night
  • changes to your face and appearance such as swollen or puffy face, acne, growth of facial hair, weight gain around your tummy and stretch marks (Cushing’s syndrome)
  • pain in different parts of the body such as the tummy (abdomen), at the site of the cancer, neck, back, joints, muscle and chest. Let your healthcare team know if you have any pain.
  • changes to your hearing. You may have ringing in your ears or ear pain. You might have hearing loss but this is rare.
  • difficulty swallowing
  • dizziness
  • heart problems including changes to the heart rhythm, heart attack, a type of chest pain (angina) caused by lack of blood flow to the heart muscle, and changes to the heart muscle making it harder for the heart to pump blood to the rest of the body
  • episodes of feeling warm and reddening of the skin (flushing)
  • unusual feelings of the skin – such as numbness, tingling, pricking, burning, a creeping skin feeling, reduced sense of touch
  • runny nose
  • a cough
  • cold hands and feet

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:

  • a second cancer many years later
  • changes in the way your kidneys work
  • taste changes
  • too little oxygen reaching the body’s organs
  • increased pressure in the skull, symptoms might include a headache, changes to your eyesight, feeling or being sick and mood changes
  • a tear in the tissue that attaches your muscle to the bone (tendon rupture)
  • inflammation around the drip site
  • sharp, severe, shooting pain anywhere in the body caused by and irritated or damaged nerve. You might also find it difficult to lift the front part of your foot and toes.
  • confusion, lack of energy and hallucinations
  • a condition where the bone marrow is unable to make all types of blood cells (aplastic anaemia)
  • a condition where the red blood cells are destroyed faster than they can be made (haemolytic anaemia)
  • a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might have flu-like symptoms such as a fever and your eyes may be more sensitive to light. This is serious and could be life threatening

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 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.

Alcohol

Gemcitabine contains a small amount of alcohol and might make you drowsy or dizzy, especially if you drink alcohol. Don't operate machinery or drive if you feel drowsy.

Pregnancy and contraception

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 with this drug and for at least a year afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

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.    

Breastfeeding

Don’t breastfeed during this treatment and for a year afterwards 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 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 Open a glossary item 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.

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 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: 
05 Aug 2021
Next review due: 
05 Aug 2024
  • Electronic Medicines Compendium 
    Accessed July 2021

  • 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

  • De Novo Treatment of Diffuse Large B-Cell Lymphoma With Rituximab, Cyclophosphamide, Vincristine, Gemcitabine, and Prednisolone in Patients With Cardiac Comorbidity: A United Kingdom National Cancer Research Institute Trial
    P A Fields and others
    Journal of Clinical Oncology, 2014. Volume32, Issue 4, Pages 282 – 287

  • Excellent outcomes using rituximab, gemcitabine, cyclophosphamide, vincristine, prednisolone (R-GCVP) in patients with DLBCL and cardiac comorbidities
    V Michalarea and others
    Hematological Oncology, 2019. Volume 37, Issue S2, Pages 425-426

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