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
. 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. You have a new cannula 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 healthcare team before you stop taking a cancer drug or if you miss a dose.
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).
Rituximab can cause an allergic reaction. So before each dose you have paracetamol, a steroid and an antihistamine drug such as chlorphenamine (Piriton).
For the first cycle of rituximab, you have it as a drip into your bloodstream slowly over a few hours. This is to prevent an allergic reaction. Your nurse will increase how fast it goes in (rate) approximately every 30 minutes if you have no allergic reaction.
Your next rituximab drip will usually go in quicker, but this will depend on how you got on with the first cycle.
You have R-GCVP in the following way:
- 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.
- You take prednisolone tablets once a day in the morning with or after food.
- You have no treatment.
- You have gemcitabine as a drip into your bloodstream for about 30 minutes.
- You have no treatment.
You then start the next 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 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.
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 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 while 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, 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.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. Don't take any over the counter medicines for cystitis. Contact your advice line instead.
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.
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 healthcare team 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, try 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 treat 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
might swell. This usually goes away on its own but tell your doctor or nurse if you have it.
Headaches
Tell your healthcare team 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, nurse or pharmacist 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 get someone pregnant 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. Let them know straight away if you or your partner falls pregnant while having treatment.
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.
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. For example, 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
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 about this treatment
For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet 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.
