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Anyone had success with gemcitabine and capecitabine (GemCap) chemo?
I was diagnosed in Aug, 2025 with adenocarcinoma of the pancreas. Oct 17 I had a distal pancreatectomy with app 70% of pancreas removed. My CT Scan on 12/16 was good, no metastasis, no changes in area of pancreas or lymph nodes tho my CA19-9 has increased to 232.
My doctor is suggesting I start the Gemcitabine-Capecitabine chemo. Has anyone had success with this chemo, especially for pancreatic cancer?
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What is the reasoning for GemCap over GemAbrax? I received Capecitabine alone while doing radiation, with success. But chemo was GemAbrax for 6 rounds. I would ask why oncology is suggesting GemCap vs GemAbrax. From the brief research I have done, seems Abrax combo is slightly superior to Cap combo, but again, ask oncologist for your particular case.
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1 ReactionDo you know what your mutations are be they germline (inherited) or somatic ( present in an organ). You should have received biopsy results after your surgery. Mutation types drive thr chemo regimen.
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3 ReactionsI had success with a combination, called the triplet Jim side being a bra scene and cisplatin with vitamin D six cycles 18 weeks and 33 days of radiation
@reme51, how are you doing on gemcitabine and capecitabine (GemCap) chemo?
@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...
@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.)
@val64
Thank you for your response. The following is from my test results:
"This individual has reduced DPD activity (activity score of
1.5) due to a heterozygous variant with reduced activity.
Based on this activity score, this individual is expected
to be an intermediate metabolizer and may be at increased
risk for severe or fatal drug toxicity when treated with
fluoropyrimidines at a standard dose."
I don't see any mention of 1 bad copy or 1 good copy, so I'm clueless here...
The test results came in Dec 21st but I haven't heard from my oncologist regarding changes to the proposed GemCap treatment but I'm sure the holidays have gotten in the way...
@reme51
"Heterozygous" is genetics-speak for one good copy of a gene and one bad (aka mutated) copy. (You have two copies of most genes, one inherited from each parent.) You probably have the same type of mutated DPYD gene as me, since mine also has reduced activity (but not zero activity), and it is the most common mutated version of the gene, being found in ~5% of people of European background, and slightly less frequently in other populations.
Hope you get more clarity from your oncologist after the holidays. Don't freak out over the scary test report comment. Happy New Year.