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Etoposide, leucovorin and fluorouracil (ELF)

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

What it is

ELF is the name of a combination of chemotherapy drugs that includes:

  • E - Etoposide
  • L - Leucovorin (also called folinic acid, FA or calcium folinate)
  • F - Fluorouracil (also called 5FU)

ELF is used to treat:

  • Stomach cancer
  • Cancer of the food pipe (oesophageal cancer)

How you have it

Fluorouracil and etoposide are clear, colourless fluids. Folinic acid is a pale yellow fluid. 

You have ELF chemotherapy drugs into your bloodstream (intravenously). 

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.

When you have it

You usually have chemotherapy as cycles of treatment. You may have up to 6 cycles of ELF. Each cycle of treatment lasts 4 weeks.

On the first day you have all 3 drugs. You have etoposide and fluorouracil as separate drips (infusions) over about an hour each. You have folinic acid as a slow injection into the cannula or central line alongside a drip of salt water (saline) over about 15 minutes.

On the second and third days you have the same drugs again.

From days 4 to 28 you have a rest with no treatment.

You then start the next treatment cycle.

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.


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.


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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