ECX (Epirubicin, cisplatin and capecitabine) | Cancer Research UK
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ECX (Epirubicin, cisplatin and capecitabine)

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


What ECX is

ECX is the name of a combination of chemotherapy drugs made up of

  • E = Epirubicin
  • C = Cisplatin
  • X = Capecitabine (also called Xeloda)

ECX is used to treat oesophageal (food pipe) cancer and stomach (gastric) cancer.


How you have ECX treatment

You usually have ECX chemotherapy as cycles of treatment. Each cycle of treatment lasts 3 weeks. Depending on your needs, you may have between 6 and 8 cycles, taking 4 to 6 months in total.

You have epirubicin and cisplatin 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 stays in place as long as you need it.

For each cycle of treatment you have epirubicin and cisplatin into your cannula or central line on the first day of treatment. You also begin taking capecitabine tablets on the first day and continue to take them twice a day for 14 days. You then have a week with no treatment. This completes 1 treatment cycle.

In some hospitals, you have capecitabine tablets every day for the whole course of your treatment, which could last for up to 6 months.

Capecitabine comes as peach coloured tablets of 150mg, 300mg or 500mg. 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 (not more than 30 minutes later). It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, 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. And never stop taking a cancer drug without talking to your specialist first.

Don’t crush or chew the tablets and wash your hands well after taking them. Store the tablets in a safe place where children can’t reach them.

The side effects associated with ECX 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 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 is usually well controlled with anti sickness medicines
  • Complete loss of head and body hair
  • A sore mouth or mouth ulcers
  • Diarrhoea occurs in up to 5 out of 10 people but is usually well controlled with anti diarrhoea medicines – drink plenty of fluids. Tell your doctor or nurse straight away 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. Tell your doctor or nurse if you have this as they can give you medicines to help
  • A change in heart rhythm due to the effect of epirubicin on heart muscle – you will have heart checks before you start treatment. Any changes will usually go back to normal after the treatment ends. But some people will have long term heart damage
  • With epirubicin your urine may become a pink or red colour for about a day after treatment – this won't harm you
  • Kidney damage – you will have blood tests before treatment, to make sure your kidneys can cope. It is important to drink plenty of water to flush the drug through. You will also have fluids through your drip before and after treatment
  • Women may stop having periods (amenorrhoea) – this may be temporary
  • 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

Occasional side effects

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

  • Loss of appetite may occur a few days after your treatment
  • Cisplatin can cause numbness or tingling in your hands or feet – it may start a few days after the treatment or some weeks later. You may have difficulty with some tasks such as doing up buttons. This usually improves a few months after the treatment is finished but continues for some people
  • Cisplatin can cause ringing in the ears (tinnitus) in about 3 out of 10 people (30%), which nearly always gets better on its own
  • Your nails may darken or have white lines on them but this grows out a few months after the end of treatment
  • Watery, sore eyes
  • Abdominal (tummy) pain – let your nurse or doctor know if you have this
  • Constipation sometimes happens in people who take capecitabine but this is generally well controlled with laxatives
  • Higher amounts of bilirubin in your blood – during treatment you will have regular blood tests to check your bilirubin levels

Rare side effects

Fewer than 1 in 100 people have these effects.

  • Cisplatin can cause some permanent hearing loss for some people
  • Blurred vision can occur after high doses of cisplatin but usually goes back to normal once the treatment has finished
  • You may notice that you find it difficult to tell the difference between certain colours during treatment and for a while afterwards
  • There is a small risk that you may get a second cancer some years after ECX treatment
  • Capecitabine can cause chest pain and swelling of the ankles

Important points to remember

You may have 1 or 2 side effects or several. 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 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.


More information about ECX

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