Gemcitabine and nab-paclitaxel

Say it: jem-SIT-uh-been and nab PAK-lih-TAK-sul

Gemcitabine and nab-paclitaxel (albumin-bound paclitaxel)

Gemcitabine and nab-paclitaxel is a two medicine chemotherapy plan given weekly through a vein, most often for pancreatic cancer.

Also called: Gem/nab-P, gem-nab, Gem-Abraxane, gemcitabine and Abraxane, Gemzar and Abraxane, gemcitabine plus nab-paclitaxel, GnP, AG, nab-paclitaxel and gemcitabine, biweekly gemcitabine and nab-paclitaxel

What it is

Gemcitabine stops cancer cells from copying their DNA. Nab-paclitaxel (brand name Abraxane) is paclitaxel attached to tiny particles of albumin, a natural protein in blood. This form does not need the strong allergy medicines regular paclitaxel needs. The two medicines work better together than gemcitabine alone. It is often chosen for people who may not handle FOLFIRINOX well. When cancer has spread, the goal is to control it, help you live longer and keep you feeling as well as possible. Before surgery, the goal is to shrink the tumor.

Often used for

• Pancreatic cancer that has spread
• Pancreatic cancer before surgery or radiation, to shrink it
• Pancreatic cancer that grew after FOLFIRINOX

Standard weekly schedule

Both medicines are given on days 1, 8 and 15, then 1 week off. Each cycle is 28 days.

Every 2 weeks (modified) schedule

Both medicines are given on days 1 and 15 of a 28 day cycle. Many cancer centers use this schedule because it can cause fewer side effects and fewer clinic visits while still working well. Your team may also switch you to it partway through treatment.

Before surgery (neoadjuvant)

Used for pancreatic cancer that may be removable, or that is close to blood vessels, to shrink it first. It is often given for a few months, sometimes followed by radiation, then surgery if scans look good.

The medicines in this plan

Nab-paclitaxel (Abraxane)

Chemotherapy that stops cancer cells from dividing. Given through a vein over about 30 minutes on days 1, 8 and 15. It is the main cause of tingling and hair loss with this plan.

Gemcitabine

Chemotherapy that blocks cancer cells from copying their DNA. Given through a vein over about 30 minutes, right after nab-paclitaxel, on days 1, 8 and 15.

How you get it

Gemcitabine and nab-paclitaxel are given in an outpatient infusion clinic, through a vein or a port (a small device under the skin of the chest). Each visit takes about 1 to 2 hours, including blood tests and anti-nausea medicine. There is no take-home pump. On the standard schedule, you get treatment on days 1, 8 and 15, then have a week off; each cycle is 28 days. For cancer that has spread, it continues as long as it is helping and you are handling it well. Scans are usually done every 2 to 3 cycles. Your schedule may be different.

A typical cycle

Day 1

Blood tests and a check in with your team. Anti-nausea medicine, then nab-paclitaxel over about 30 minutes, then gemcitabine over about 30 minutes.

Days 2 to 7

You may feel tired, achy or feverish (flu-like) for a day or two. Energy usually improves within a few days.

Day 8 and day 15

Blood tests, then the same two medicines again. If your counts are too low, a dose may be lowered or skipped.

Days 16 to 28

A week off treatment. Blood counts are often lowest around this time, then recover before the next cycle.

Common side effects and what helps

• Tingling, numbness or burning in fingers and toes. It can build up over time. Tell your team early so they can adjust the dose.
• Low blood counts, which raise the risk of infection, bleeding and anemia. Wash hands often and stay away from people who are sick.
• Tiredness, which can build up over the weeks. Short walks and rest breaks both help.
• Hair loss. It usually starts a few weeks after the first treatment and grows back after treatment ends.
• Flu-like feelings such as fever, chills or body aches for a day or two after gemcitabine. Ask which medicine you can take.
• Nausea, poor appetite and weight loss. Eat small meals often and ask to see a dietitian.
• Swelling in the ankles or legs, and skin rash.
• Diarrhea or constipation. Drink plenty of fluids and follow the plan your team gave you.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• New swelling, pain, warmth or redness in one leg or arm (people with pancreatic cancer have a higher risk of blood clots)
• Sudden shortness of breath, chest pain or coughing up blood, which can be a sign of a blood clot in the lungs
• A new or worse dry cough or trouble breathing (rarely, gemcitabine can cause lung inflammation)
• Yellow skin or eyes, very dark urine, or itching (which can mean a blocked bile duct)
• Bleeding that will not stop, black stools, or many new bruises
• Passing much less urine, or dark or bloody urine
• Not able to keep fluids down, or feeling dizzy when you stand

Good to know

• People with pancreatic cancer have a high risk of blood clots. Your team may suggest a blood thinner. Know the signs of a clot and call right away if they happen.
• Blood tests are done before every treatment day, not just the start of each cycle.
• Nerve damage from nab-paclitaxel can make it hard to button clothes, write or walk safely. Tell your team, because pausing or lowering the dose can help prevent lasting damage.
• Nab-paclitaxel is not the same as regular paclitaxel. The doses and schedules are different and they cannot be swapped.
• If you had a stent placed in a bile duct, fever with chills or yellow skin could mean the stent is blocked or infected. Call right away.
• Tumor testing for gene changes (such as BRCA, KRAS or MSI) is recommended for pancreatic cancer, because results may open up other treatment options.

At home

• Keep a thermometer at home and check your temperature if you feel unwell, warm or shaky.
• Protect your hands and feet: wear shoes indoors, check your feet daily for cuts, and use a night light to prevent falls if your feet feel numb.
• Drink about 8 to 10 cups of fluid a day unless your team told you otherwise.
• Stay as active as you can, and avoid sitting still for long periods, to lower the risk of blood clots.
• If you take enzyme pills with meals for pancreatic cancer, keep taking them as directed; they can help with weight and loose stools.
• Use a soft hat or scarf to keep warm and protect your scalp from the sun if your hair thins.

Questions to ask

• What is the goal of my treatment, and how will we know it is working?
• Will I be on the weekly schedule or the every 2 weeks schedule?
• Do I need a blood thinner to prevent clots?
• What should I do if the tingling in my hands and feet gets worse?
• Has my tumor been tested for gene changes?
• Should I see a dietitian to help with weight and appetite?

Pancreatic cancer

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.