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Anyone had success with gemcitabine and capecitabine (GemCap) chemo?
Pancreatic Cancer | Last Active: Dec 31, 2025 | Replies (8)Comment receiving replies
@colleenyoung I'm scheduled to start GemCap on Jan 8th. But, my DYPD test results now show I have an enzyme deficiency that causes serious risk (severe toxicity and/or death) if I am on Capecitabine. My oncologist wants to start at a reduced dose but I'm not sure I want to start it at all! Very disheartening...I'm considering Gemcitabine alone. I realize that the effectiveness will be limited if done that way, but quality of life is also important. No one has discussed mutations with me, not even sure if I was tested?? GemCap was chosen for the "lesser side effects", but now that has changed. I don't think I would tolerate Abraxane, a bit lost at the moment...
Replies to "@colleenyoung I'm scheduled to start GemCap on Jan 8th. But, my DYPD test results now show..."
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@reme51
I actually decided to go on GemCap, even though it is not normally used for the type of cancer I have (endometrial), because I have a DPYD mutation. I have one bad copy (which they call HapB3) and one good copy. I assume you do too, because if you had two bad copies, they wouldn't let you take Cap at all. I'm a geneticist and have a lot of data on my tumor, so I realized that my tumor has actually lost the good copy, so I figured it might be more sensitive to GemCap than my normal cells would be.
The normal doses for a person my size would be ~1350 mg Cap twice daily, and 1600 mg Gem at each infusion. I started at 800 mg Cap (2x daily) and 1000 mg Gem (I approved the reduced dose of Cap, but my oncologist snuck in the reduced dose of Gem, and I've been trying to get her to increase it.) I just started my third cycle, and I'm up to 1250 mg Cap and 1300 mg Gem.
People with one bad copy of DPYD sometimes have bad side effects from Cap or 5-FU and sometimes don't. I'm not really having any troublesome side effects. I'm being careful about using moisturizer on my hands and feet, and I can see how there might be trouble if I didn't. I've had a couple brief episodes of diarrhea, but I think it was only when the meal I had before taking Cap wasn't substantial enough.
If I were you, I'd go ahead and start the GemCap with the reduced Cap dose. I feel quite good on this drug combo. (This is my 7th different type of chemotherapy, and it is one of the two best in terms of how I feel.)