Gemcitabine and paclitaxel (GemTaxol)

Gemcitabine and paclitaxel is the name of a chemotherapy combination. It is also called GemTaxol. It includes the drugs:

• gemcitabine (also called Gemzar)
• paclitaxel (also known as Taxol)

It is a treatment for advanced breast cancer and bladder cancer. Advanced breast cancer is also called secondary breast cancer.

How does gemcitabine and paclitaxel work?

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

How do you have gemcitabine and paclitaxel?

You have both drugs into your bloodstream (intravenously).

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. You have a new cannula each time you have treatment.

When do you have gemcitabine and paclitaxel?

You usually have gemcitabine and paclitaxel as cycles of treatment. This means you have the drugs and then a rest to let your body recover.

Each cycle of treatment lasts 21 days (3 weeks). You may have up to 6 cycles of treatment. It takes about 4 months in total.

If you have secondary breast cancer you may have treatment for longer. This depends on if the treatment is working and you have had no serious side effects.

You have each cycle of treatment in the following way: 

You then start a new cycle of treatment. 

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 gemcitabine and paclitaxel?

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. 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, 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).

Difficulty breathing

You may have difficulty breathing and feel wheezy. This is normally mild and will go away on its own. But you should let your healthcare team know straight away.

Rarely you can get severe difficulty breathing or problems such as scarring or fluid in your lungs. So you should also let your health care team know immediately if you have a cough or get chest pains.

Tiredness and weakness (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.

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.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Sore mouth

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

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. Your nurse will give you medicines beforehand to try to prevent a reaction. 

Allergic reactions are more common when you have paclitaxel than gemcitabine.  An allergic reaction to paclitaxel usually happens during the first or second treatment.

Low blood pressure

Tell your doctor or nurse if you feel lightheaded or dizzy. You have your blood pressure checked regularly.

A build up of fluid (swelling)

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

Skin problems

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your healthcare team can tell you what products you can use on your skin to help.

Numbness or tingling in fingers and toes

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

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. 

Some people may have permanent hair loss although this is very rare.

Aching joints and muscles

You might feel some pain from your muscles and joints. Speak to your doctor or nurse about what painkillers you can take to help with this.

Blood and 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.

Liver changes

You might have mild liver changes. These are unlikely to cause symptoms. They usually go back to normal when treatment finishes.

Rarely these changes might be more severe.

You have regular blood tests to check for any changes in the way your liver is working.

Flu-like symptoms

You may have headaches, muscle aches (myalgia), a high temperature and shivering. You should contact your advice line urgently if you have these symptoms.

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:

• back pain

• difficulty having a poo - this is called constipation

• runny nose

• sweating

• a slow heart beat - this is called bradycardia

• loss of appetite

• headaches

• inflammation around the drip site

• nail and skin changes - this is normally temporary

• difficulty sleeping or you might feel like sleeping lots

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• a serious reaction to an infection (sepsis) - symptoms include slurred speech, confusion, extreme shivering, muscle pain, passing no urine (in a day), severe breathlessness and mottled or discoloured skin. Call 999 or go to your local Accident and Emergency (A&E) immediately if you have any of these
• blood clots - signs of blood clots include pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot in the lung
• stroke
• high blood pressure
• heart problems such as an irregular heartbeat, heart muscle changes, or even less commonly a heart attack
• kidney problems such as kidney failure or small blood clots in the blood vessels inside the kidney (haemolytic uremic syndrome)
• a rare disorder called systemic capillary leak syndrome which can cause a sudden drop in blood pressure
• 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
• a second cancer such as acute myeloid leukaemia or myelodysplastic syndrome
• seizures (fits)
• bowel problems such as your bowel stops working or a blockage in the bowel
• serious skin problems including Stevens-Johnson syndrome - a severe skin reaction that may start as tender red patches leading to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening

Contact your advice line or doctor straight away if you have any symptoms of these side effects.

Other side effects

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

• gemcitabine
• paclitaxel

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 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.    

Pregnancy and contraception

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 because the drug may come through into 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, 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 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. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

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

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.