EOX

EOX is the name of a chemotherapy combination. it includes the drugs we list below, next to each drug we have how you pronounce the drug in brackets:

• E – epirubicin (epee-roob-i-sin)
• O – oxaliplatin (ox-al-e-plait-in)
• X – capecitabine (cap-site-a-been). It is also known as Xeloda. This is the oral form of 5-fluorouracil.

You might have it as a treatment for oesophageal or stomach cancer. 

How does EOX work?

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

How do you have EOX?

You have epirubicin and oxaliplatin as a drip into your bloodstream (intravenously). And you take capecitabine as tablets.

You might 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

You take capecitabine twice a day. You should take them within 30 minutes after eating a meal (breakfast and dinner). You swallow them whole with water. 

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

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.

How often do you have EOX?

You have EOX chemotherapy as a cycle of treatment .  Each cycle lasts 3 weeks (21 days). Depending on your cancer type you have between 6 and 8 cycles.

You have each cycle of treatment in the following way:

You then start a new treatment cycle.

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.

Before starting treatment with capecitabine you have a blood test to check levels of an enzyme called dihydropyrimidine dehydrogenase (DPD). A low DPD level means you are more likely to have severe side effects from these drugs. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor, pharmacist or nurse will talk to you about this.

What are the side effects of EOX?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist 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

• the side effects are affecting your daily life

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased 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. 

Bruising, bleeding gums and nosebleeds 

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 petechiae).

Less often bleeding can happen from other areas of the body such as your gut and back passage (rectum). Let your medical team know if you notice any blood from your rectum or in your poo.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Breathlessness and looking pale

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

Tiredness and weakness (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.

Tummy (abdominal) and back pain

Tell your treatment team if you have this. They can work out the cause and give you medicine to help relieve the pain.

Sore mouth and ulcers

It may be painful to swallow drinks or food. Painkillers and mouth washes can help to reduce the soreness and keep your mouth healthy. 

Numbness and tingling in fingers and toes

Numbness or tingling in fingers or toes is often temporary and can usually improve slowly after you finish treatment. Talk to the team looking after you when you first notice this, especially if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Increased sensitivity to the cold

Oxaliplatin can make you more sensitive to the cold. It can affect your throat causing it to feel as though it is difficult to breathe and swallow. This can happen whilst you have oxaliplatin or within 2 hours of it finishing. It’s only temporary but can feel quite frightening.

Opening and closing the fridge or freezer, touching metal, eating or drinking cold foods and changes in temperature from the weather can trigger this. 

It can help wearing gloves and avoid very cold food and drink for 24 hours before and after oxaliplatin.

Let your nurse know straight away if it's affecting your breathing and swallowing.

Hair thinning and loss

Your hair may thin or 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. 

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

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.

Soreness, redness and peeling on palms and soles of 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.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Let your doctor or nurse know as you may be able to have creams to help manage this.

Skin and nail problems

Skin and nail problems include a skin rash, dry skin, itching and darker skin. Your nails may also become brittle, dry, change colour or develop ridges. This usually goes back to normal when you finish treatment.

Your skin may appear red and flushed.

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Inflammation around the drip or injection site

Tell your nurse straight away if you have any pain, redness, swelling or leaking around your drip site.

Also let them know if it causes pain along the vein when you have the injection. 

Allergic reactions

A reaction may happen during the infusion. Symptoms can include a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction. 

Cough or breathing problems

You might develop a cough or difficulty breathing due to an infection such as pneumonia. Or it can just be due to the drugs. Let your team know immediately if this happens.

Weight gain

You may gain weight while having this treatment. You may be able to control it with diet and exercise. Tell your healthcare team if you are finding it difficult to control your weight. 

This can happen if you have EOX after having the main treatment for your cancer (adjuvant treatment ).

It can also happen if you are having EOX because your cancer has spread but it occurs less often.

High blood sugar levels

High blood sugar levels can cause headaches, feeling thirsty and blurred vision. You have regular tests to check your blood sugar levels. You may need to check your levels more often if you have diabetes .

Changes in levels of salts or minerals in your blood

You may have changes in levels of minerals and salts in your blood, such as low potassium and high or low sodium. Less often these drugs can make your bloods show low levels of calcium and magnesium.

You have regular blood tests during treatment to check this.

Kidney changes

You might have some changes in the way your kidneys work. You have regular blood tests to check how well they are working.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include: 

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms.
• constipation
• a high temperature (fever) with a low level of white blood cells. This can be life threatening contact the advice line or the healthcare team if you have a high temperature.
• changes to how the heart works
• a dry mouth
• lack of fluid in the body (dehydration)
• passing wind (flatulence)
• depression
• difficulty sleeping (insomnia)
• dizziness
• hiccups
• pain in your gut, joints, bones, jaw, and chest
• problems with moving your body causing weakness, clumsiness, loss of balance and falls
• an increase in sweating
• problems passing urine, blood in your urine or both
• inflammation of the membranes covering the brain and spinal cord (meninges) causing symptoms similar to meningitis such as stiff neck, headaches and unable to look at bright light
• inflammation of the voice box (larynx) making it difficult to speak, swallow, causing a sore throat and feeling of difficulty breathing
• eye problems such as inflammation and seeing double

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include: 

• a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering. Contact your advice line straight away if you have any of these symptoms.
• a second cancer such as acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML). Talk to your doctor if this is of concern to you.
• the abnormal breakdown of red blood cells
• feeling nervous
• the imbalance of chemicals in your blood making it too acidic this can cause fast breathing, confusion, sleepiness, fatigue, or fast heart rate
• blockage or slow movement of the gut
• blood clotting problem causing bruising and severe bleeding
• scarring and thickening of the lung tissue causing difficulty breathing
• an increase in uric acid in the blood that can cause inflamed joints. You have regular blood tests to check this.
• hearing changes such as ringing or buzzing in the ears (tinnitus) or loss of hearing
• a harmless lump caused by an overgrowth of fat cells
• earache
• yellowing of the skin and white of the eyes (jaundice)
• soreness and redness where you had radiotherapy before

Other side effects

For more information about the side effects of individual drugs:

• epirubicin
• oxaliplatin
• capecitabine

Coping with side effects

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

What else do you need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment. Talk to your doctor or nurse about effective contraception before starting treatment.

Women must not become pregnant for at least 9 months after the end of treatment. Men should not father a child for at least 6 months after treatment. 

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment. 

Loss of fertility

You may not be able to become pregnant or get someone pregnant 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 might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

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 one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can 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 the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

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