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Epirubicin, carboplatin and capecitabine (ECarboX)

ECarboX is the name of a chemotherapy combination that includes: 

  • epirubicin (Pharmorubicin)
  • carboplatin
  • capecitabine (Xeloda)

It is a possible treatment for oesophageal cancer and stomach cancer. 

How it works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How you have ECarboX

You have:

  • capecitabine as tablets that you swallow whole with plenty of water within 30 minutes of eating
  • epirubicin as an injection into your bloodstream (intravenously) 
  • carboplatin as a drip into your bloodstream over 30 minutes

Into your bloodstream (intravenously)

You have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Taking capecitabine tablets 

You must take tablets according to the instructions your doctor or pharmacist gives you.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have EcarboX

You have ECarboX as cycles of treatment each lasting 3 weeks. Depending on your needs, you can have up to 8 cycles, taking around 6 months in total.

You have each cycle of treatment in the following way:

Day 1
  • You have epirubicin as an injection into your vein
  • You have carboplatin as a drip into the bloodstream over 30 minutes
  • You take capecitabine tablets in the morning and evening
Day 2 to 21
  • You take capecitabine tablets in the morning and evening

You then start the next cycle of treatment.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your advice line or your doctor or nurse immediately if you have signs of infection, such as a temperature above 37.5C or below 36C, or if you develop a severe skin reaction. Signs of a severe skin reaction include peeling or blistering of the skin.

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them. They include: 

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia).

Tiredness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will grow back once treatment has finished. But it is likely to be softer. And it may grow back a different colour or be curlier than before. 

Mouth sores and ulcers

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Diarrhoea

Contact your advice line if you have diarrhoea, that is 4 loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid, or if it carries on for more than 3 days. Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty of liquid to replace the fluid lost.

Soreness, redness and peeling on palms or soles of the feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Heart problems

You may get heart problems, such as angina, heart failure or a heart attack. You will have regular heart checks during and after the treatment. Tell your doctor or nurse straight away if you have any chest pain.

Red or pink urine

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Kidney problems

To help prevent kidney damage, it is important to drink plenty of water. You might also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.

Skin changes

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes.

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:

  • loss of appetite
  • loss of taste or a metallic taste in your mouth
  • hearing loss that usually gets better on its own after treatment has finished
  • numbness or tingling in fingers and toes
  • nail changes such as darker nails or white lines may appear on them
  • watery and sore eyes
  • tummy (abdominal) pain
  • constipation
  • liver changes that are very mild and unlikely to cause symptoms

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • a second cancer some years after treatment
  • swollen ankles
  • an allergic reaction that can cause a skin rash, shortness of breath, redness or swelling of the face, feeling hot and dizziness
  • a ringing sound in your ears (tinnitus) that often gets better on its own once the treatment finishes
  • a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know

Other medicines, foods and drinks 

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility 

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding 

Don’t breastfeed during this treatment and for 2 weeks after your final treatment. This is because the drug may come through into your breast milk.

Treatment for other conditions 

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who have had live vaccines as injections

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

Lactose intolerance

This drug contains lactose (milk sugar). If you have an intolerance to lactose, contact your doctor before taking this medicine.

DPD deficiency 

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine. These side effects can rarely be life threatening. It doesn’t cause symptoms so you won’t know if you have a deficiency. Talk to your doctor if you are worried and about whether you need to have a test to check for it. 

Contact your doctor if your side effects are severe.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
22 Oct 2018
  • Combination chemotherapy with carboplatin, capecitabine and epirubicin (ECarboX) as second- or third-line treatment in patients with relapsed ovarian cancer: a phase I/II trial
    C Rothermundt and others
    British Journal of Cancer, 2006. Vol 94, Issue 1, Pages 74–78

  • Electronic Medicines Compendium (eMC)
    Assessed October 2018

  • Consent forms for SACT (Systemic Anti-Cancer Therapy)
    Cancer Research UK, accessed October 2018

  • E – CARBO – X
    St Luke's Cancer Alliance, accessed October 2018

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