GDP

GDP is the name of a cancer drug combination. You have:

• G – gemcitabine (jem-site-uh-been)
• D – dexamethasone (deks-uh-meth-uh-zone) 
• P – cisplatin (sis-pla-tin)

It is a treatment for Hodgkin and non-Hodgkin lymphoma.

How does GDP work?

Gemcitabine and cisplatin are chemotherapy drugs. These drugs destroy quickly dividing cells, such as cancer cells.

Dexamethasone is a 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 do you have GDP?

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

You have gemcitabine and cisplatin as a drip 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

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Risk of tissue damage

When you are having this treatment through a cannula it could damage the tissue if it leaks out of the vein. This is called extravasation. This can happen anywhere along the vein that the drug is going into. It doesn’t happen very often. Tell your nurse straight away if you notice any changes such as swelling, redness, pain, burning, or a stinging feeling.

Your nurse will stop the drug treatment. And they will treat the area to relieve symptoms and reduce tissue damage. Contact your healthcare team if you develop any of these symptoms when you are at home.

Taking your tablets

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

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.

How often do you have GDP?

You have GDP as cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover.

Each cycle of treatment lasts 21 days (3 weeks). You may have up to 6 cycles of treatment. Your doctor will tell you the number of cycles you will have. 

Exactly how you have the cancer drugs depends on your situation. The following is an example:

You then start the next cycle of treatment.

GCSF injection

You might also have a drug called granulocyte colony stimulating factor (G-CSF). This makes your bone marrow produce white blood cells more quickly after treatment. It helps lower your risk of getting an infection.

Your doctor will tell you if you need G-CSF and for how long. 

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.

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV . This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system and can cause the virus to become active again (reactivation). 

What are the side effects of GDP?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

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

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

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 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, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling 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. 

Bruising, bleeding gums or nosebleeds

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. This is known as petechiae.

Breathlessness and looking pale

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

Swelling of different parts of the body

A build up of fluid  that may cause swelling in your arms, hands, ankles, legs, face or other parts of the body. This is called oedema. It usually gets better after treatment finishes. Contact your healthcare team if this happens to you.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.

Skin reactions and changes

You might get a skin rash with this combination of drugs. The skin rash can be a reaction to the treatment.

Another common skin problem includes itching. Your skin might be sore, peel, scale, blister, or ulcer. These are rarer side effects.

Your skin usually goes back to normal when your treatment finishes. Let your healthcare team can tell you what products you can use on your skin to help. Also if you have a temperature or are more sensitive to light.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs 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. 

Tiredness and weakness (fatigue) during and after treatment 

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

High temperature or chills 

You might get a high temperature. Or you might feel cold or start shivering (chills). 

Flu like symptoms 

These may include headaches, muscle aches, a high temperature, shivering and generally feeling tired and weak. Other symptoms can include a cough, runny nose and generally feeling unwell.

Ask your healthcare team if you can take medicines such as paracetamol to 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.

Blood and protein in your pee

You might have small amounts of blood and protein in your pee. These are picked up when your nurse tests your pee. 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.

Difficulty breathing 

You may have difficulty breathing with wheezing and coughing. Let your healthcare team know straight away if this happens. 

More rarely you might have breathlessness, damage to the lungs or temporary narrowing of the bronchial tubes. This might cause wheezing or a cough.

Let your healthcare team know if you have any breathing problems. 

Changes in blood test results

You may have changes in the levels of minerals in your blood, including low levels of sodium. You have regular blood tests during treatment to check this.

You may have other changes picked up in blood tests, for example changes to how well your pancreas is working. These changes are usually mild and go back to normal after treatment finishes.

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:

• sepsis - a serious reaction to an infection. Signs can include feeling very unwell, not peeing, a very high or very low temperature, shivering, slurred speech or confusion, breathlessness, mottled or discoloured skin, extreme shivering or muscle pain. Call 999 or go to accident and emergency (A&E) immediately if you have any of these symptoms
• diarrhoea
• loss of appetite
• difficulty falling or staying asleep (insomnia)
• feeling sleepy or very drowsy
• hearing changes such as ringing or buzzing in the ear (tinnitus) and ear pain
• heart problems such as an abnormal heart rhythm, slow or fast heartbeat. More serious but rare heart problems include a heart attack or the sudden stopping of your heart
• 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
• a blocked, runny or itchy nose or sneezing
• back pain
• mouth sores and ulcers
• sweating
• muscle aches and pain
• headaches
• cough
• constipation

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 stroke
• posterior reversible encephalopathy syndrome (PRES) - a rare disorder of the nerves causing headache, fits, confusion and changes in vision - contact your health team straight away. This condition is reversible
• kidney problems such as kidney failure or small blood clots in the blood vessels inside the kidney (haemolytic uremic syndrome)
• abnormal sperm production in men
• low magnesium levels in the blood, symptoms include - muscle cramps, tiredness or nausea
• fits (seizures)
• a second cancer such as acute leukaemia
• an allergic reaction - a reaction may happen during the infusion. Symptoms can include a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Tell your doctor or nurse immediately if at any time you feel unwell. They will slow or stop your drip for a while and give you medicine to help relieve your symptoms.

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

• changes to your face and appearance – such as puffy face, stretch marks, acne or increased facial hair
• high or low blood sugar levels
• weakened bones that are fragile and more likely to break (osteoporosis)
• adrenal insufficiency - when your adrenal glands don’t make enough of the hormones your body needs to handle stress, control blood pressure and balance salt and sugar levels. This can lead to symptoms like extreme tiredness, low blood pressure, and weight loss
• increased appetite and weight gain
• mood changes such as depression, anxiety, mood swings or feeling manic
• inflammation of your pancreas - symptoms include severe tummy pain, feeling or being sick, a high temperature or you may have loose poo. Tell your doctor or nurse if you get these symptoms
• slow wound healing
• hiccups
• high levels of types of fat in your blood called cholesterol and triglycerides. You will have regular blood tests to check this

If you have side effects that aren’t listed on this page, you can look at the individual drug pages:

• gemcitabine
• dexamethasone
• cisplatin

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to become pregnant or get someone pregnant 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 get someone pregnant while you're having treatment and for at least 6 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment. 

Breastfeeding 

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

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

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, and yellow fever.

You can usually 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 a vaccine in relation to your cancer treatment.

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your immune system is weakened.

Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.

More information

For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug on this website.

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