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E-CMF (Epi-CMF)

Find out what E-CMF is, how you have it and other important information about having E-CMF.

E – CMF is a chemotherapy combination. It is sometimes called Epi-CMF. It includes the drugs:

  • E (Epi) – epirubicin
  • C – cyclophosphamide
  • M – methotrexate
  • F – fluorouracil

It is a treatment for breast cancer.

How E - CMF works

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

How you have E-CMF

You may have all the drugs into your bloodstream. Or you may have cyclophosphamide as tablets.

Into your bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Taking your tablets or capsules

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

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.

Never stop taking a cancer drug without talking to your specialist first.

When you have E-CMF

You usually have chemotherapy as cycles of treatment. E-CMF is given in two parts. You first have 4 doses of epirubicin over 3 months. Then you have the other 3 drugs (CMF) over the next 4 months. The course of treatment takes about 7 months in total.

There are two ways to have E-CMF chemotherapy, depending on whether you are having cyclophosphamide injections or tablets. Your doctor or nurse will explain which one you are having and why.

Having injection only

If you are having all the drugs as injections, you have treatment in the following way. 

Every 3 weeks, for 12 weeks, you have an injection of epirubicin. So you have 4 injections in total. This completes your 4 cycles of epirubicin. 

You then have the CMF part of the treatment. You have cyclophosphamide, methotrexate and 5FU injections on the first day of your cycle and again a week later. You then have a break for 3 weeks. This completes one cycle (4 weeks). 

You repeat the cycle 4 times over 4 months.

Having cyclophosphamide as tablets

If you have cyclophosphamide as tablets, you have the epirubicin every 3 weeks for 12 weeks. 

Then you have 4 cycles of CMF. From the first day of your cycle, you take cyclophosphamide tablets daily for 2 weeks. You swallow the tablets with water, ideally on an empty stomach. On the first day you also have methotrexate and 5FU injections. A week later you repeat these injections. After you finish your cyclophosphamide tablets you have a break with no drugs for 2 weeks. This completes one cycle of the CMF over 4 weeks. 

You repeat this cycle 4 times over 4 months.

Tests during treatment

You have blood tests before starting treatment 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

Important information

Other medicines, foods and drink

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.

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 are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

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.

Breastfeeding

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

Treatment for other conditions

Always tell other doctors, nurses 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 at least 6 months afterwards.

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

You can:

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

Avoid contact with people who’ve had live vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. The virus is in the baby’s urine for up to 2 weeks and can make you ill. So, you mustn't change their nappies for 2 weeks after their vaccination.

You also need to avoid anyone who has had oral polio or typhoid vaccination recently.

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.

Information and help

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