What are the common side effects of Gemcitabine and cisplatin?

Nausea and vomiting, sometimes starting a few days after treatment. Tiredness. Low blood counts, which raise the risk of infection, bleeding and tiredness. Ringing in the ears or trouble hearing high sounds from cisplatin. Tingling or numbness in the fingers and toes. Fever, chills or flu-like aches for a day or so after gemcitabine. Poor appetite and changes in taste. A rash or mild swelling of the legs or ankles. Hair thinning (complete hair loss is not common).

When should I call my care team during Gemcitabine and cisplatin?

A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills; Throwing up that keeps you from drinking fluids or keeping down your medicines for 24 hours; Much less urine than usual, very dark urine, or feeling dizzy when you stand; Sudden hearing loss or loud ringing in the ears; Trouble breathing, a new cough, or chest pain; Bleeding that will not stop, blood in your urine or stool, or many new bruises; Swelling or pain in one leg; With immunotherapy: severe diarrhea, belly pain, yellow skin or eyes, or a bad rash.

Gemcitabine and cisplatin

Say it: JEM-SIT-uh-been and SIS-plat-in

Gemcitabine and cisplatin

Gemcitabine and cisplatin is a two medicine chemotherapy plan used for bladder cancer and several other cancers, given on days 1 and 8 of a 3 week cycle.

Also called: GC, Gem-Cis, GemCis, gem cis, cisplatin and gemcitabine, CisGem, gemcitabine cisplatin, Gem-Cis with durvalumab, Gem-Cis with pembrolizumab, Gem-Cis with nivolumab, gem-carbo, gemcitabine and carboplatin

What it is

Gemcitabine and cisplatin damage cancer cells in different ways, and they work better together. Before bladder surgery, the goal is to shrink the cancer and lower the chance it comes back. When cancer has spread, the goal is to shrink it, slow it down and help you live longer and feel better. For some cancers, an immunotherapy medicine is added to help your immune system fight the cancer.

Often used for

Bladder cancer that has grown into the bladder muscle, before surgery to remove the bladder
Bladder and other urothelial cancers that have spread
Bile duct and gallbladder cancer (biliary tract cancer) that cannot be removed or has spread, along with durvalumab or pembrolizumab
Some lung cancers, and nasopharyngeal cancer (cancer behind the nose)

Before bladder surgery (neoadjuvant): Usually 4 cycles before the bladder is removed. Some people also get durvalumab with the chemotherapy and then for several months after surgery.
Bladder cancer that has spread: Usually 4 to 6 cycles. If the cancer shrinks or stays the same, avelumab is often started afterward to help keep it in check. Gem-cis with nivolumab is another option. Your team may also talk with you about other first treatments, such as enfortumab vedotin with pembrolizumab.
Biliary tract cancer with durvalumab or pembrolizumab: Gem-cis plus an immunotherapy medicine, every 21 days. Cisplatin is usually stopped after about 8 cycles, and the immunotherapy (sometimes with gemcitabine) continues as long as it is helping.
Gem-carbo (gemcitabine and carboplatin): Used when cisplatin is not safe, for example because of weak kidneys, hearing loss, nerve damage, heart failure or low energy. Carboplatin is easier on the kidneys and hearing but tends to lower blood counts more.
Nasopharyngeal cancer: Gem-cis may be given for a few cycles before chemotherapy with radiation, or for cancer that has spread, often with an immunotherapy medicine.

The medicines in this plan

Gemcitabine: Chemotherapy that stops cancer cells from copying their DNA. Given through a vein over about 30 minutes on day 1 and day 8.
Cisplatin: Platinum chemotherapy. Given through a vein with extra IV fluids, usually on day 1 (some centers split it over days 1 and 8). It is the medicine that can affect the kidneys and hearing.
Carboplatin: Only in the gem-carbo version. A platinum chemotherapy that is easier on the kidneys and hearing, used in place of cisplatin when cisplatin is not safe.
Durvalumab: Only in some versions. An immunotherapy medicine given through a vein on day 1, used with gem-cis for biliary tract cancer and, in some cases, before and after bladder surgery.
Pembrolizumab: Only in some versions. An immunotherapy medicine given through a vein on day 1, used with gem-cis for biliary tract cancer.
Nivolumab: Only in some versions. An immunotherapy medicine that may be added for bladder cancer that has spread.
Avelumab: Not given with the chemotherapy. An immunotherapy medicine that may be started after gem-cis for bladder cancer that has spread, to help keep the cancer under control (maintenance).

How you get it

Gem-cis is given in an outpatient infusion clinic through a vein or a port (a small device placed under the skin of the chest). Day 1 takes about 4 to 6 hours because cisplatin needs IV fluids before and after it. Day 8 is shorter, about 1 to 2 hours. Each cycle is 21 days. Before bladder surgery, most people get 4 cycles; for cancer that has spread, usually 4 to 6 cycles. Your schedule may be different.

A typical cycle

Day 1: Blood tests, including kidney tests, and a check in with your team. Then anti-nausea medicines, IV fluids, gemcitabine and cisplatin. Any add-on immunotherapy is also given.
Days 2 to 5: Nausea is most likely now, and can show up 2 to 3 days after treatment. Keep taking your anti-nausea medicines and drink plenty of fluids.
Day 8: Blood tests, then gemcitabine through the vein (and cisplatin if your center splits the dose).
Days 9 to 21: Rest and recovery. Blood counts are often lowest in the second week. Energy usually comes back before the next cycle.

Common side effects and what helps

Nausea and vomiting, sometimes starting a few days after treatment. Take your anti-nausea medicines on schedule, even when you feel fine.
Tiredness. Plan lighter days after treatment and take short walks when you can.
Low blood counts, which raise the risk of infection, bleeding and tiredness. Wash hands often and stay away from people who are sick.
Ringing in the ears or trouble hearing high sounds from cisplatin. Tell your team right away if you notice it.
Tingling or numbness in the fingers and toes.
Fever, chills or flu-like aches for a day or so after gemcitabine. This can be normal, but always check your temperature and call if it reaches the fever level.
Poor appetite and changes in taste. Eat small meals often.
A rash or mild swelling of the legs or ankles.
Hair thinning (complete hair loss is not common).

Call your care team right away if you have

A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
Throwing up that keeps you from drinking fluids or keeping down your medicines for 24 hours
Much less urine than usual, very dark urine, or feeling dizzy when you stand
Sudden hearing loss or loud ringing in the ears
Trouble breathing, a new cough, or chest pain
Bleeding that will not stop, blood in your urine or stool, or many new bruises
Swelling or pain in one leg
With immunotherapy: severe diarrhea, belly pain, yellow skin or eyes, or a bad rash

Good to know

Cisplatin can harm the kidneys. Your kidney blood tests are checked before each cycle, and you get extra IV fluids with every cisplatin dose.
Your team may check your hearing before you start and if you notice any changes.
Cisplatin can lower magnesium and potassium. You may need extra by mouth or through the IV.
Not everyone can safely get cisplatin. If your kidneys, hearing or overall strength are a concern, your team may use carboplatin instead.
Rarely, gemcitabine can cause lung irritation or kidney and blood problems. Tell your team about new shortness of breath, swelling or much less urine.
If you get immunotherapy, side effects can show up even months later and can affect almost any organ. Tell every doctor you see that you have had immunotherapy.

At home

Drink about 8 to 10 cups of fluid a day for the first few days after cisplatin, unless your team told you otherwise.
Keep anti-nausea medicines at home and know which ones to take on a schedule and which ones to take as needed.
Ask before taking pain medicines such as ibuprofen or naproxen, which can be hard on the kidneys.
Keep a thermometer at home and check your temperature if you feel unwell.
Write down any changes in hearing, tingling or urine so you can share them at your next visit.

Questions to ask

Is this treatment meant to shrink the cancer before surgery, or to control cancer that has spread?
How many cycles will I get?
Are my kidneys and hearing healthy enough for cisplatin, or should I get carboplatin?
Will an immunotherapy medicine be added during or after chemotherapy?
What should I do if nausea starts a few days after treatment?
How will we know if the treatment is working?

Bladder cancer

Sources

Quick answers

What is Gemcitabine and cisplatin?: Gemcitabine and cisplatin is a two medicine chemotherapy plan used for bladder cancer and several other cancers, given on days 1 and 8 of a 3 week cycle. Gemcitabine and cisplatin.
How is Gemcitabine and cisplatin given?: Gem-cis is given in an outpatient infusion clinic through a vein or a port (a small device placed under the skin of the chest). Day 1 takes about 4 to 6 hours because cisplatin needs IV fluids before and after it. Day 8 is shorter, about 1 to 2 hours. Each cycle is 21 days. Before bladder surgery, most people get 4 cycles; for cancer that has spread, usually 4 to 6 cycles. Your schedule may be different.
What are the common side effects of Gemcitabine and cisplatin?: Nausea and vomiting, sometimes starting a few days after treatment. Tiredness. Low blood counts, which raise the risk of infection, bleeding and tiredness. Ringing in the ears or trouble hearing high sounds from cisplatin. Tingling or numbness in the fingers and toes. Fever, chills or flu-like aches for a day or so after gemcitabine. Poor appetite and changes in taste. A rash or mild swelling of the legs or ankles. Hair thinning (complete hair loss is not common).
When should I call my care team during Gemcitabine and cisplatin?: A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills; Throwing up that keeps you from drinking fluids or keeping down your medicines for 24 hours; Much less urine than usual, very dark urine, or feeling dizzy when you stand; Sudden hearing loss or loud ringing in the ears; Trouble breathing, a new cough, or chest pain; Bleeding that will not stop, blood in your urine or stool, or many new bruises; Swelling or pain in one leg; With immunotherapy: severe diarrhea, belly pain, yellow skin or eyes, or a bad rash.

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.