GemCis (Gemcitabine and Cisplatin)

https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/gemcis

GemCis
GemCis is used to treat different types of cancer.

On this page

• What is GemCis?
• How GemCis is given
• About side effects
• Side effects while treatment is being given
• Common side effects
• Less common side effects of GemCis
• Other information
• How we can help

What is GemCis?
GemCis is a combination of cancer drugs. It is used to treat different types of cancer.
It is best to read this information with our general information about chemotherapy and the type of
cancer you have.
GemCis is named after the chemotherapy drugs used:

• Gem – gemcitabine
• Cis – cisplatin.

Your doctor will talk to you about this treatment and its possible side effects before you agree
(consent) to have treatment.

More information about this treatment
This information is correct at time of publishing. But sometimes the types of cancer this treatment is
used for, or treatment side effects, may change between revision dates.
You can talk to your cancer team if you want more detailed information about this treatment. Or visit
the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for
individual drugs.

How GemCis is given
You usually have GemCis in a chemotherapy day unit or during a stay in hospital.
During your course of treatment, you will meet someone from your cancer team, such as a:

• cancer doctor
• chemotherapy nurse or specialist nurse
• specialist pharmacist.

This is who we mean when we mention doctor, nurse or pharmacist in this information.
Before or on the day of each treatment, you will have a blood test. This is to check that it is safe for
you to have treatment.
You will meet with a doctor, nurse or pharmacist before you have treatment. They will talk to you
about your blood results and ask how you have been feeling. If your blood results are okay, the
pharmacy team will prepare your cancer drugs.
Your nurse will usually give you anti-sickness drugs before the cancer drugs. You will have your
cancer treatment through 1 of the following:

• a cannula – a short, thin tube the nurse puts into a vein in the arm or hand
• a central line – a fine tube that goes under the skin of the chest and into a vein close by
• a PICC line – a fine tube that is put into a vein in the arm and goes up into a vein in the chest
• an implantable port (portacath) – a disc that is put under the skin on the chest or arm and goes into a vein in the chest.

Your cancer team may also give you anti-sickness drugs and other medicines to take home. Take all
your capsules or tablets exactly as they tell you to.
Your nurse will give you gemcitabine as a drip (infusion). This takes about 30 minutes. They will also
give you the cisplatin as a drip. This takes between 1 and 4 hours. You will have one drug followed
by the other. The nurse usually runs the drip through a pump, which gives you the treatment over a
set time.
Cisplatin can affect the kidneys. To help prevent kidney damage you will get extra fluids through the
drip before and after the cisplatin. You may also have a drug called mannitol which is given as a drip.
Or you will have a drug called furosemide, which is given as a tablet or an injection.
Your nurse will explain how long it will take to have the extra fluids. They will also give you advice
about how much fluid to drink in the 24 hours after your treatment.

Your course of chemotherapy
You usually have a course of several cycles of treatment over a few months. GemCis can be given in
different ways and each cycle can take 21 days or 28 days. Your nurse or doctor will discuss your
treatment plan with you.

About side effects
We explain the most common side effects of this treatment here. We also include some that are less
common.
You may get some of the side effects we mention, but you are unlikely to get all of them. And you
may have some side effects, including rarer ones, that we have not listed here.
Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you:

• drugs to help control some side effects
• advice about managing side effects.

It is important to take any drugs exactly as explained. This means they will be more likely to work for
you.

Serious and life-threatening side effects
Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening.
Your doctor, nurse or pharmacist can explain the risk of these side effects to you.

Contact the hospital
Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel
unwell or need advice, you can call at any time of the day or night. Save these numbers in your
phone or keep them somewhere safe.

Side effects while treatment is being given
Some people may have side effects while they are being given the chemotherapy or shortly after
they have it:

Allergic reaction
Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

• feeling hot or flushed
• shivering
• itching
• a skin rash
• feeling dizzy or sick
• a headache
• feeling breathless or wheezy
• swelling of your face or mouth
• pain in your back, tummy or chest.

Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any
of these signs, tell them straight away. If you do have a reaction, they can treat it quickly.
Sometimes a reaction happens a few hours after treatment. If you develop any of these signs or feel
unwell after you get home, contact the hospital straight away on the 24-hour number.
Always call 999 if swelling happens suddenly or you are struggling to breathe.

Flu-like symptoms
Gemcitabine may cause flu-like symptoms such as:

• feeling hot, cold or shivery
• having a headache
• aching.

You may have these symptoms while the drug is being given or several hours later. Your nurse will
tell you if this is likely to happen. They may advise you to take paracetamol. If the symptoms are
severe or do not improve after 24 hours, contact the hospital. If you have flu-like symptoms at any
other time, you should contact the hospital straight away.

Breathlessness
You may feel mildly breathless soon after you have gemcitabine. This usually gets better by itself.
But if you feel breathless, let your doctor, nurse or pharmacist know.

The drug leaks outside the vein
Sometimes cancer drugs that are given into a vein may leak outside the vein. If this happens, some
drugs can damage the tissue near the vein. This is called extravasation. Extravasation is not
common, but it is important that it is dealt with quickly. If you have any of the following symptoms
around the vein during or after your treatment, tell your nurse straight away:

• stinging
• pain
• swelling
• if you have white skin, the area may become red
• if you have black or brown skin, the area may become darker.

Common side effects
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If
your white blood cell count is low, you may be more likely to get an infection. A low white blood cell
count is called neutropenia.
An infection can be very serious when the number of white blood cells is low. It is important to get
any infection treated as soon as possible. If you have any of the following symptoms, contact the
hospital straight away on the 24-hour number:

• a temperature above 37.5°C
• a temperature below 36°C
• you feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough
• breathlessness
• diarrhoea
• needing to pass urine (pee) often, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.
Your white blood cell count will usually return to normal before your next treatment. You will have a
blood test before having more treatment. If your white blood cell count is low, your doctor may delay
your treatment for a short time, until your cell count increases.

Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the
blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:

• nosebleeds
• bleeding gums
• heavy periods
• blood in your urine (pee) or stools (poo)
• tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin.

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour
number. You may need a drip to give you extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen
around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

• very low in energy
• breathless
• dizzy and light-headed.

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may
need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red
blood cells. This is called a blood transfusion.

Effects on the kidneys
This treatment can affect how the kidneys work. You will have blood tests before and during
treatment to check how well your kidneys are working.
Before and after each treatment, your nurse will give you extra fluids through a drip. This is to protect
your kidneys.
Drinking fluids also helps protect your kidneys. The advice is usually to try to drink at least 2 litres
(3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how
much is right for you.
Contact the hospital on the 24-hour number if you are:

• not able to drink as much as you have been asked to – for example, if you feel sick
• sick (vomit) or have diarrhoea
• passing less urine or peeing less often than usual
• have blood in your urine (pee).

Feeling sick
Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control
sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent
sickness than to treat it after it has started.
If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink
enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact
the hospital on the 24-hour number as soon as possible. They will give you advice. They may
change your anti-sickness treatment. Let them know if you still feel sick.

Loss of appetite
This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your
appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or
pharmacist. They can give you advice. They may give you food or drink supplements. Or they may
suggest changes to your diet or eating habits to help.

Diarrhoea
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for
you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it
may be more active than usual.
If you are passing loose stools 3 or more times a day and this is not normal for you, contact the
hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help.

They might also ask you for a specimen of your stool to check for infection.

Constipation
This treatment can cause constipation. Constipation means that you are not able to pass stools
(poo) as often as you normally do. It can become difficult or painful. Here are some tips that may
help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital on the 24-hour number for advice. They can give you
drugs called laxatives to help.
If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour
number straight away.

Changes to your taste
Some foods may taste different or have no taste. Try different foods to find out what tastes best to
you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can
give you advice. It might help to try:

• sucking sugar-free sour or boiled sweets
• eating cold foods
• eating sharp-tasting fresh fruit.

Taste changes usually get better after treatment ends. We have more information about coping with
changes to taste.

Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make
you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or
dentures in the morning, at night and after meals.
Contact the hospital straight away on the 24-hour number, if:

• a sore mouth or throat affects how much you can drink or eat
• your mouth, tongue, throat or lips have any blisters, ulcers or white patches.

They can give you advice, and mouthwash or medicines to help with the pain or to treat any
infection. Follow their advice and make sure you:

• drink plenty of fluids
• avoid alcohol and tobacco
• avoid food or drinks that irritate your mouth and throat.

Effects on the liver
This treatment can affect how your liver works. This usually goes back to normal after treatment. You
will have blood tests to check how well your liver is working during your treatment.

Skin changes
Gemcitabine can cause an itchy skin rash due to an allergic reaction. If this happens, contact your
doctor, or call the number you have been given.
Always tell your doctor or nurse about any skin changes. They can give you advice and may give
you creams or medicines to help. Any changes to your skin are usually temporary and improve when
treatment finishes.
Rarely, this treatment can cause a serious skin reaction that needs to be treated immediately in
hospital. Contact the hospital straight away on the 24-hour number if you have any of these
symptoms:

• a skin rash that is spreading
• blistering or peeling skin
• flu-like symptoms, such as a high temperature and joint pain
• sores on your lips or in your mouth.

Hair loss
Your hair will get thinner. Or you may lose all the hair from your head. You may also lose your
eyelashes and eyebrows, as well as other body hair. Hair loss usually starts after your first or second
treatment.
If you want to cover up hair loss, there are different ways you can do this. Your nurse will give you
information about coping with hair loss.
Remember to protect your skin from the sun. Use suncream with a sun protection factor (SPF) of at
least 30 on your scalp. Or cover up with a hat or scarf.
Hair loss is almost always temporary. Your hair will usually grow back after treatment ends.

Fluid build-up
This treatment can cause a build-up of fluid in the body. This will slowly get better after treatment
ends. Contact the hospital on the 24-hour number if you:

• are gaining weight
• have swelling in your face, legs or ankles.

They can give you advice and treatment to help.

Hearing changes
This treatment may cause hearing changes, including hearing loss. You may have ringing in the
ears. This is called tinnitus. You may also become unable to hear some high-pitched sounds.
Hearing changes may get better after this treatment ends. But this does not always happen. If you
notice any changes in your hearing, tell your doctor, nurse or pharmacist.

Effects on the heartbeat
GemCis can cause fast, irregular or slow heartbeats. Tell your doctor if you notice any changes.
Rarely, cisplatin can cause more serious heart problems. If you have any of these symptoms during
or after treatment, call the 24-hour number the hospital has given you straight away:

• pain or tightness in your chest
• feeling breathless or dizzy
• your heart is beating too fast
• your heart is beating too slowly.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If
you cannot get through to your doctor, call the NHS urgent advice number on 111.

Feeling tired
Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment
and for some weeks after it ends. Try to pace yourself and plan your day so you have time to rest.
Gentle exercise, like short walks, can help you feel less tired.
If you feel sleepy, do not drive or use machinery.

Problems sleeping or feeling drowsy
Gemcitabine can affect your sleep. You may have difficulty sleeping or feel drowsy. If you feel sleepy,
do not drive or operate machinery.

Less common side effects of GemCis
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor, nurse or pharmacist if you develop:

• a cough that does not go away
• wheezing
• breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check
your lungs.

Effects on the brain
Rarely, this treatment causes a brain condition that can be serious. You can make a full recovery
from this. But it must be diagnosed and treated quickly.
This condition can cause:

• a headache that does not get better
• drowsiness or confusion
• changes in eyesight
• fits (seizures).

If you have any of these symptoms, it is important to either:

• contact the hospital straight away on the 24-hour number
• go to the hospital straight away.

You should not drive yourself to hospital.

Muscle or joint pain
You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your
doctor, nurse or pharmacist. They can give you painkillers and advice. They can also tell you if any of
the painkillers you usually take are suitable.
Tell them if the pain does not get better. Having warm baths and resting regularly may help.

Numb or tingling hands or feet (peripheral neuropathy)
This treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or
pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly
tasks such as fastening buttons or tying shoelaces.
If you have these symptoms, always tell your doctor, nurse or pharmacist. They sometimes need to
change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends.
But for some people they continue and are a long-term side effect of treatment.

Other information
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital
straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood.
Your doctor, nurse or pharmacist can give you more information about preventing and treating blood
clots.

Alcohol
Some preparations of this treatment contain alcohol. If having alcohol is a problem for you, tell your
doctor, nurse or pharmacist. Your blood alcohol level may be above the legal limit after you have the
treatment. Do not drive or operate machinery for a few hours after having this treatment, even if you
feel okay.

Salt
This treatment contains salt (sodium). Talk to your doctor if you are on a low-salt diet.

Other medicines
Some medicines can affect how this treatment works or be harmful while you are having it. Always
tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such
as:

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Vaccinations
Cancer doctors usually recommend that people with cancer have vaccinations for flu and
coronavirus (covid). They may also recommend other vaccines, such as Shingrix® for shingles.
These all help reduce your risk of serious illness from these infections. Most people can have these
vaccines, including people with weak immune systems.
You should not have live vaccines if your immune system is weak. This includes if you are having or
recently had chemotherapy, radiotherapy or other cancer treatments that affect your immune system.
Live vaccines can make you unwell because they contain a very weak version of the illness they
protect you against. There are several live vaccines, including the yellow fever vaccine.
It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can
explain what vaccines are right for you and when it is best to have them.

Contraception
Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone
pregnant while having this treatment and for some time afterwards. The drugs may harm a
developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use
• how long after treatment you should continue to use contraception.

Fertility
Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are
worried about this, it is important to talk with your doctor before you start treatment.

Sex
It is possible that small amounts of chemotherapy may be passed on through vaginal fluids or
semen. If you have sex in the first few days after treatment, your cancer team will usually advise
using condoms or a dental dam to protect your partner.

Changes to periods
If you have periods, these may become irregular or stop while you are having this treatment. They
might return after treatment, but this does not always happen. Your menopause may start sooner
than it would have done. Your doctor, nurse or pharmacist can give you more information.

Breastfeeding
You are advised not to breastfeed while having this treatment, or for some time after treatment ends.
This is because the drugs could be passed to the baby through breast milk.
Your doctor, nurse or pharmacist can give you more information.

Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the healthcare
professional that you are having cancer treatment. Give them the contact details for your cancer
doctor or cancer team so they can ask for advice.
If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to
your cancer team before you have any dental treatment.

About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer
Information Development team. It has been reviewed by expert medical and health professionals
and people living with cancer.

References
Visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for
more detailed information. The leaflet lists all known side effects.

Date reviewed
Reviewed: 01 July 2024 | Next review: 01 July 2026

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