Epirubicin

Epirubicin (Ellence) is a type of anthracycline chemotherapy. It is made from the Streptomyces peucetius bacteria.

Epirubicin is FDA approved in the U.S. but is used less often here than in other countries. It is also sometimes called epirubicin hydrochloride.

How epirubicin works

Epirubicin binds to the DNA inside cancer cells. This causes the DNA to get tangled up and damaged. The cells cannot divide, which causes them to die. Epirubicin works at all points in the growth of the cell.

Who gets epirubicin

Epirubicin may be used in chemotherapy treatment regimens for most types of invasive breast cancer that require chemotherapy, including triple-negative breast cancer. It can also be used as part of regimens that include trastuzumab (Herceptin), to treat HER2-positive breast cancers and lower the risk of recurrence. It is not given at the same time as trastuzumab because both trastuzumab and epirubicin can affect heart health.

This medicine can be used in early-stage disease that requires chemotherapy to lower the risk of breast cancer coming back. It can be given either before surgery as neoadjuvant therapy or after surgery as adjuvant treatment.

In metastatic breast cancer, it can be given either alone or with other medicines.

How epirubicin is given

Epirubicin is usually given with other chemotherapy medicines. In some cases, it may be used instead of doxorubicin (Adriamycin) because epirubicin may cause less heart damage than doxorubicin. Regimens with epirubicin include:

• FEC (5FU, Epirubicin and Cyclophosphamide) or CEF
• EC (Epirubicin and Cyclophosphamide)

Epirubicin is given by vein. It is often given once every 3 weeks for six cycles, or twice (on days one and eight) every 28 days for six cycles.

Side effects and things to remember

Common side effects include:

• Decrease of white blood cells, red blood cells and platelets
• Fatigue
• Hair loss
• Menopausal symptoms
• Mouth sores
• Nausea and vomiting
• Pain near the site where the medicine was given

Less common side effects include:

• Diarrhea
• Infection
• Nail changes
• Eye problems
• Fertility problems
• Heart problems

Before starting epirubicin, be sure to tell your doctor about any medicines you are taking, including vitamins, herbal supplements, and over-the-counter medicines. You should not take epirubicin if you are pregnant.

Epirubicin can cause problems with your heart. Share any existing or previous health problems with your doctor, especially if you have a history of heart disease. Your doctor will test you for heart problems before you start treatment and monitor your heart closely during treatment.

There is a very small risk of developing leukemia, a cancer of the blood, after taking this medicine, especially when it is given in high doses or together with certain other chemotherapy medicines—talk to your doctor about this risk.

Seek immediate medical care if you develop fever, shortness of breath, difficulty breathing, swelling, hives, or blistering at the IV site.

Your doctor, pharmacist or nurse can help you manage your side effects. You can also go to our section on Side Effects for more information.