Epirubicin, carboplatin and capecitabine (ECarboX)

ECarboX is a chemotherapy treatment for oesophageal and stomach cancer.

What is ECarboX?

ECarboX is the name of a chemotherapy combination that includes: 

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

It is a treatment for oesophageal (food pipe) cancer and stomach cancer. 

How does ECarboX work?

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

How do 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 (intravenously) you can have this between 15 and 60 minutes

Into your bloodstream (intravenously)

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

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. You have a new cannula each time you have treatment.

Taking capecitabine tablets 

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 healthcare team before you stop taking a cancer drug or if you miss a dose.

How often do you have ECarboX?

You have ECarboX as cycles of treatment each lasting 3 weeks. This means that you have the drug and then a rest to allow your body to recover.

Each cycle of treatment lasts around 3 weeks (21 days). You might have up to 8 cycles, taking around 6 months in total.

You have each cycle of treatment in the following way:

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.

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 ECarboX?

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. 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:

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 on your arms or legs (known as petechiae) or general bruising, but this is less common.

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. 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.

Swelling of the veins (phlebitis) and blood clots 

This might start during your infusion or afterwards. Rarely, you might have a blood clot in the deep veins. Tell your doctor immediately if you have:

• pain and swelling in one of your legs, usually at the back of your leg below the knee
• warm, red skin in the affected area
• shortness of breath
• chest pain, which may be worse when breathing in

Hair loss

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

Mouth problems

You may have a burning or tingling feeling in your mouth. You may also have a dry mouth or mouth sores and ulcers that can be painful or your mouth may feel numb. But these are less common. 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. 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.

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.

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

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

This can include pain when you pass your wee, or blood in your wee, or your wee may be a different colour. Your kidneys may stop working, but this is very rare.

Skin changes

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your healthcare team can tell you what products you can use on your skin to help.

You may get a fungal infection, but this is rare. You might have blisters or red painful skin in areas where you may have previously had radiotherapy or your skin might be sensitive to sunlight. This is also very rare.

Eye problems

You might have eye problems, such as inflammation of the white tissue of your eye (pink eye or conjunctivitis). Symptoms include itchy, watery or gritty eyes. Or you might have inflammation of the clear, dome shaped tissue on the front of your eye (keratitis). Symptoms include pain, blurred vision, watery eyes, and sensitivity to light. You may have double vision or loss of sight, but this is rare. 

Let your doctor or nurse know if you have any problems with your eyes. They can give you eye drops to help.

Periods stopping

Women might stop having periods (amenorrhoea) but this may be temporary.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Loss of appetite and taste changes 

You might lose your appetite for various reasons when you are having cancer treatment. Sickness or tiredness can put you off food and drinks. 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 goes back to normal a few weeks after your treatment finishes.  
You may feel unwell if you are not eating enough. Symptoms include feeling weak or tired, or not being able to concentrate properly. 

Tummy (abdominal) cramps and pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. You may also have bloating in your tummy, but this is less common.

General numbness in your body fingers and toes

You might have numbness or tingling around your body. You may notice it more in your fingers or toes. This is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Headaches

Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.

Fluid build up in your legs

You may have swelling of your legs due to a build up of fluid (oedema). 

Sore throat

Your throat might get sore. It may be painful to swallow drinks or food. Ask the team looking after you if you can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.

Tell your doctor or nurse if your throat is sore.

Blood pressure changes

Tell your doctor or nurse if you have headaches, nose bleeds, blurred or double vision or shortness of breath. Rarely you might have low blood pressure. 

Pain, itching or burning feeling at the back of your throat 

You might have an unusual feeling at the back of your throat (pharynx). You may have pain, but this is less common. Let your doctor know if you have any of these side effects. 

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative. You may also notice that you pass more wind (flatulence).  

Nail changes

During treatment, your nails may become brittle and dry or change colour. Talk to your doctor or nurse if this happens.

Indigestion or heartburn

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Joint or muscle pain

You might feel some pain in your muscles and joints. Less commonly you may have pain in your jaw or have problems opening your mouth or you may feel weak. Speak to your doctor or nurse if you have any of these symptoms. They can tell you what painkillers you can take to help with this.

Hot flushes

We have some tips for coping with hot flushes and the possible treatments for men and women. Talk to your doctor if your hot flushes are hard to cope with. They might be able to prescribe you some medicines.

High temperature 

You might get a high temperature (fever) for a few hours after having this treatment. Tell your doctor or nurse if you have a fever. You may also feel you are not able to cope with the heat or hot weather, making you feel weak and tired or you may sweat a lot. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and10%). You might have one or more of them. They include:

• heavy bleeding (haemorrhage) this may be from your bottom (rectum) or your vagina. You might see blood if you are sick (vomit). Call your advice line if you have any unusual bleeding
• a ringing or buzzing in your ears (tinnitus). Or you may have hearing loss that usually gets better on its own after treatment has finished
• pain in the food pipe (oesophagus)
• an allergic reaction that can cause a skin rash, shortness of breath, redness or swelling of the face, feeling hot and dizziness
• shortness of breath and a cough, you must let your doctor know if you have these side
• depression
• difficulty sleeping (insomnia)
• dizziness
• a runny or itchy nose - this may cause you to sneeze more often or your nose may feel blocked, or you might have nose bleeds
• developing flu symptoms including, feeling tired, a headache, feeling feverish, a cough, and shivering
• heart problems, such as angina, heart failure or a heart attack. You might have an irregular heartbeat. You have checks during and after the treatment. Tell your doctor or nurse straight away if you have any chest pain
• a change in the mineral levels in your blood, you will have regular blood tests to check for these
• difficulty sleeping
• feeling worried about things (anxiety)
• changes to your nervous system, symptoms include tingling in your fingers and toes or a stabbing, burning or sharp or sharp pain caused by a damaged nerve
• loss of touch or abnormal sensation in parts of your body hiccups
• changes to your voice
• changes in the way your liver works, you may notice that your poo is a light colour or your skin becomes itchy or looks yellow
• excessive sweating, this may be worse at night
• pain around the drip or injection site

Rare side effects

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

• a second cancer some years after treatment
• lipoma- this is an overgrowth of fat cells. This is not a cancer
• your blood taking longer to clot when you have a bleed
• diabetes
• not interested in having sex
• high levels of fat in the blood
• fainting or feeling faint
• lung problems - symptoms can include feeling out of breath, coughing up blood and wheezing
• inflammation or a blockage in your bowels
• 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

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 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.    

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 

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.

Lactose intolerance

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

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.