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


What ECF is

ECF is the name of the chemotherapy treatment that is a combination of the drugs

  • Epirubicin
  • Cisplatin
  • Fluorouracil (5FU)

Click on the links above to find out the side effects of each individual drug.

ECF is used to treat stomach cancer and cancer of the food pipe (oesophagus). Sometimes the 5FU (given as a drip) is replaced by capecitabine (Xeloda) that is taken as tablets. Then the combination is called ECX.


How you have ECF treatment

You have ECF in 3 week cycles of treatment. You may have 6 to 8 cycles lasting up to 6 months in total.

ECF drugs are liquids. Epirubicin is a red liquid and fluorouracil and cisplatin are clear liquids. You have epirubicin and cisplatin every 3 weeks as injections into a drip (infusion). They go into a thin tube in your arm called a PICC line.

You have fluorouracil (5FU) non stop into your PICC line all the way through your treatment. The dose rate is controlled by a portable pump. You have this part of the treatment at home, as an outpatient. You will have to go back to the hospital every week to have the pump refilled or replaced. In some hospitals the 5FU drip is replaced by capecitabine tablets that you take every day for 3 weeks.

The side effects associated with ECF are listed below. Use the links (underlined) to find out more about each side effect. For more information on side effects where there is no link, please see our cancer drug side effects section, or use the search box at the top of the page.


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, bleeding gums after brushing your teeth, or 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 can be severe with cisplatin and epirubicin. But it is usually well controlled with anti sickness tablets or injections. If sickness happens, it usually starts a few hours after each treatment and lasts for about a day. If your sickness is not controlled tell your doctor or nurse. They can change your anti sickness medicines to others that work better for you
  • Epirubicin can turn your urine pink or red for about one day after treatment – this won't harm you
  • Loss of appetite
  • Hair loss – most people have complete hair loss with epirubicin
  • Diarrhoea – you need to drink plenty of fluids if you have diarrhoea. Tell your doctor or nurse if it is severe or continues
  • A sore mouth or mouth ulcers
  • Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. 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
  • Skin changes may occur, including rashes (which may be itchy), darker skin, and sensitivity to sunlight. You may also have redness or soreness in areas of skin previously treated with radiotherapy
  • Kidney damage may happen with cisplatin – you will have blood tests before your treatment, to make sure your kidneys are able to cope with the drug. To help prevent damage it is important to drink plenty of water. You will also have fluids into your vein before and after your treatment

Occasional side effects

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

  • Inflammation around the drip siteif you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse straight away
  • Allergic reactions can happen while you are having the ECF treatment – let your nurse or doctor know straight away if you have a sudden skin rash, itching, breathlessness or swelling of the lips, face or throat
  • Your nails may become darker and may have white lines on them
  • Sore eyes
  • Watery eyes
  • Gritty eyes and blurred vision
  • Brown marking on the skin along the vein where 5FU has been injected
  • Soreness and redness of the palms of the hands and soles of the feet (sometimes called hand and foot syndrome or palmar-plantar syndrome) – the skin may peel
  • Numbness or tingling in fingers and toes – this can cause difficulty with fiddly things such as doing up buttons. It starts within a few days or weeks and usually goes within a few months of finishing treatment. Some people may have permanent numbness
  • You may have ringing in the ears (tinnitus) which nearly always gets better on its own
  • Loss of taste or a metallic taste in your mouth
  • Damage to heart muscle from epirubicin, which is usually temporary but for a small number of people it may be permanent – your doctor will check your heart before and after your treatment

Rare side effects

Fewer than 1 in 100 people have these effects.

  • Heart problems – there is a small risk of angina or a heart attack
  • Swelling of hands and feet due to fluid build up
  • Confusion or unsteadiness
  • There is a small risk of developing another cancer some years after finishing the treatment

Important points to remember

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount 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 a few 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.


Related information


More information about ECF

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information 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: 23 October 2014