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Treatment Name: Gemcitabine + Abraxane®

Gemcitabine + Abraxane® is a Chemotherapy Regimen for Pancreatic Cancer

How does Gemcitabine + Abraxane work?
Each of the medications in Gemcitabine + Abraxane are designed to kill cancer cells.

Other names for Abraxane:

  • paclitaxel protein-bound
  • nab-paclitaxel
  • albumin-bound paclitaxel

Goals of therapy:
Gemcitabine + Abraxane (paclitaxel protein-bound) is given to shrink tumors and alleviate symptoms of pancreatic cancer. It is commonly given with the goal of cure if the disease is not metastatic (spread outside the area of the pancreas) and when combined with surgery. If the disease is metastatic (spread outside of the pancreas), it is not commonly given with the goal of cure, but to relieve symptoms, and improve quality of life.


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  • Paclitaxel protein-bound I.V. over 30 minutes on Days 1, 8, and 15
  • Gemcitabine intravenous infusion (I.V.) over 30 minutes on Days 1, 8, and 15

Estimated total infusion time for this treatment:

  • Up to 2 hours for Days 1, 8, and 15 of each cycle
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

Both drugs are given each cycle unless the doctor stops one drug for toxicity.

This treatment is usually given in an outpatient infusion center, allowing the person to go home afterwards.

These drugs are repeated every 28 days. This is known as one Cycle. Each cycle may be repeated up to six times (six months), depending upon response, tolerability, and number of cycles prescribed.

Click here for common starting doses.


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Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with gemcitabine + Abraxane are shown here:

Side effect videos Side Effect Videos
Fatigue Fatigue Hair LossHair LossNausea and VomitingNausea and VomitingNeutropenic FeverNeutropenic FeverAnemiaAnemiaDiarrheaDiarrheaBleedingBleedingPainPain


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How often is monitoring needed?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others the doctor may order. The CA19-9 (a tumor marker) is usually checked at the beginning of treatment, then about every eight weeks thereafter to determine if the chemotherapy drugs are working.

How often is imaging needed?
Imaging may be checked before treatment. Imaging may include: magnetic resonance imaging (MRI) or computerized tomography (CT) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue gemcitabine + Abraxane as planned, or delay or switch therapy.


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ChemoExperts Tips

  • Abraxane comes from the manufacturer as a powder for reconstitution and can take 20 to 30 minutes to fully dissolve (reconstitute) before loading into the I.V. bag. Plan on extra wait time if the infusion center pharmacy is busy
  • Abraxane is always infused first to help boost the effect of gemcitabine
  • Radiation therapy is NOT usually given within seven days of a full dose of gemcitabine. Your cancer doctor and/or radiation doctor should review the timing of gemcitabine with radiation if it is part of the treatment plan
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for pancreatic cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Gemcitabine + Abraxane®, we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Gemcitabine + Abraxane®. Depending upon your income, they may be able to help cover the cost of:

  • Gemcit­abine
  • Pacli­taxel protein-bound

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Gemcitabine + Abraxane® and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Gemcitabine + Abraxane®

Individual Drug Label Information

Gemcit­abine (Gemzar®)

  • Gemcitabine is an intravenous infusion
  • Toxicity is increased with infusion time greater than one hour or dosing more than once per week
  • Liver and kidney function should be monitored regularly to minimize toxicity
  • Dosage adjustments may be required for low white blood cells, low platelets, or liver dysfunction
  • Known to cause fetal harm; this drug should be avoided during pregnancy 
General gemcitabine (Gemzar) side effects
  • Low red and white blood cells
  • Low blood platelets
  • Fever
  • Nausea & vomiting
  • Increased liver enzymes and toxicity
  • Diarrhea
  • Bleeding
  • Skin rash
  • Pins and needles tingling & pain in hands and feet
  • Hair loss
  • Kidney problems and fluid retention
  • Although rare, can cause serious lung injury or shortness of breath
  • Click on the gemcitabine (Gemzar) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossBleedingBleedingPainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Pacli­taxel protein-bound (Abraxane®)

  • Abraxane is an intravenous infusion
  • Extreme caution is advised when this is given to patients with low white blood cells, known as neutrophils, are below a certain level.  Blood counts are usually checked before each infusion
  • Dosage adjustments may be required for liver dysfunction, low white blood cells, low platelets, nerve damage, or poor liver function
  • May interact with certain antifungal and seizure medications. Ask your doctor or pharmacist to review your medications for any possible interactions
  • May interact with grapefruit and grapefruit juice. This could increase your risk of experiencing side effects. Avoid eating grapefruit and drinking anything containing grapefruit juice during treatment
  • Although rare, can cause serious lung injury or shortness of breath
  • Known to cause fetal harm; this drug should be avoided during pregnancy
General Abraxane (paclitaxel protein bound particles) Side Effects
  • Low white blood cells
  • Infections due to low white blood cells may occur
  • Fever
  • Low blood platelets
  • Bleeding
  • Allergic reactions can occur
  • Pins and needles or a tingling feeling in the fingers and toes. This is reversible if caught early; notify doctor if this happens
  • Liver damage
  • Lung injury
  • Hair loss (minimal)
  • Fatigue
  • Nause and vomiting (minimized with pre-medication)
  • Diarrhea
  • Anemia
  • Click on the Abraxane® (paclitaxel protein-bound particles) package insert below for all reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingPainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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Von Hoff DD, Ervin T, Arena FP, et al. Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus Gemcitabine. N Engl J Med 2013;369:1691-1703.

Created: December 16, 2015 Updated: May 4, 2017

What is Pancreatic Cancer?

A disease of the cells of the pancreas organ. There are different types of pancreatic cancer, the most common being pancreatic adenocarcinoma that accounts for about 85% of cases. This type affects the digestive enzymes produced by the pancreas. Risk factors include: smoking tobacco, obesity, diabetes, and some rare genetic conditions. It can spread to neighboring organs such as: liver, duodenum, stomach, colon, spleen, and kidneys.

Pancreatic cancer is treated with surgery, chemotherapy, radiation therapy, a combination of all these, or sometimes supportive care alone. Surgery can be curative, but it can also be used to reduce tumor size and improve quality of life. The stage can vary at diagnosis and throughout treatment. The Tumor, Node, Metastasis (TNM) staging system is used to stage pancreas cancer. Staging systems describe the extent of cancer throughout the body and help doctors determine which treatments to offer. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

Common Starting Doses

Paclitaxel protein-bound 125 mg/m2 I.V. over 30 minutes on Days 1, 8, and 15
Gemcitabine 1000 mg/m2 intravenous infusion over 30 minutes on Days 1, 8, and 15

Cycle is 28 days

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

14) Serum calcium

What does "cure" mean?

<p>The word &ldquo;cure&rdquo; means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI&rsquo;s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word &ldquo;remission&rdquo; more often. This means there are no signs or symptoms of cancer. Patients in&nbsp;remission&nbsp;are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in&nbsp;remission&nbsp;to prevent the cancer from coming back.</p>
<p>Doctors usually do not consider a patient &ldquo;cured&rdquo; until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.</p>