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This page tells you about the chemotherapy drug combination ECarboX and its possible side effects. There is information about


What ECarboX is

ECarboX is the name of a combination of chemotherapy drugs that includes

  • E – Epirubicin
  • Carbo – Carboplatin
  • X – Capecitabine (also called Xeloda)

The links above take you to information about the individual side effects of each drug.

ECarboX is a treatment for some types of advanced cancer, including

  • Food pipe cancer (oesophageal cancer)
  • Stomach cancer
  • Ovarian cancer

The side effects associated with EcarboX are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drug side effects section.


How you have ECarboX

Epirubicin is a red liquid and carboplatin is a clear fluid. You have these drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. The tube can stay in place throughout the course of treatment.

Capecitabine comes as peach coloured tablets. Take the tablets according to the instructions your doctor or pharmacist gives you. Your doctor will tell you which dose you need to take. You take the tablets twice a day. Swallow them whole, with plenty of water, soon after your breakfast and evening meal (no more than 30 minutes after eating). Don’t crush or chew them. It is important to wash your hands well after taking them. Store them out of the reach of children. Never stop taking a cancer drug without talking to your specialist first.

You usually have ECarboX chemotherapy as cycles of treatment. You may have between 6 and 8 cycles. Each cycle lasts 3 weeks.

On the first day, you have an injection of epirubicin into your cannula or central line, alongside a drip of salt water (saline). You then have a drip (infusion) of carboplatin over 30 minutes. You begin taking capecitabine tablets and continue to take them every day for 21 days.

This completes one cycle of your treatment. You then start your next cycle with epirubicin and carboplatin. You take capecitabine tablets every day for the whole course of your treatment, which may last up to 24 weeks.


Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – 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 and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Feeling or being sick is usually well controlled with anti sickness medicines
  • Complete hair loss, including body hair – this is temporary and the hair grows back after the treatment ends
  • A sore mouth or mouth ulcers
  • Diarrhoea occurs in up to half of people who have capecitabine and can be severe. It is usually well controlled with anti diarrhoea medicines. Drink plenty of fluids and tell your doctor or nurse immediately if diarrhoea becomes severe, or continues for more than 3 days. Make sure you follow any special advice you have been given about how to cope with diarrhoea
  • Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (palmar – plantar syndrome). This may cause tingling, numbness, pain and dryness. Your nurse will give you creams to reduce the soreness
  • Damage to heart muscle from epirubicin, which is usually temporary. For a small number of people the changes may be permanent. Your doctor will check your heart before and after your treatment
  • Epirubicin may make your urine a pink or red colour for about a day after treatment – this is nothing to worry about
  • Carboplatin can cause kidney damage so you will have blood tests before your treatment, to make sure your kidneys are able to cope. To help prevent damage it is important to drink plenty of water and you will have fluids by drip before and after your treatment
  • Women may stop having periods (amenorrhoea) but this may be temporary
  • Skin changes, such as rashes, darkening, sensitivity to light, and soreness in areas previously treated with radiotherapy. Don't sit out in the sun and do remember to cover up or use sun block on exposed skin
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. 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

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.


Rare side effects

Fewer than 1 in 100 people have these effects.

  • There is a small risk that you may get a second cancer some years after EcarboX treatment
  • Swelling of the ankles
  • Chest pain
  • An allergic reaction while having carboplatin treatment, usually at the first or second treatment. Let your nurse know straight away if you have any skin rashes, itching or shivering. Also tell them if you have a red face, a headache, shortness of breath, anxiety, dizziness, or a sudden need to pass urine
  • Ringing in their ears (tinnitus) affects about 1 in 100 people (1%)

Important points to remember

You may have a few of the side effects mentioned on this page. They may be mild or more severe. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

  • How many times you've had a drug before
  • Your general health
  • How much of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

These drugs may 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 at least 3 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Do not breastfeed during this treatment because the drugs may come through in the breast milk.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


More information about ECarboX drugs

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information about these drugs look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 31 December 2014