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


What ELF is

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

  • E – Etoposide
  • L – Leucovorin – also known as folinic acid, FA or calcium folinate
  • F – Fluorouracil

The underlined links above take you to information about the individual side effects of each of those drugs. Folinic acid is a drug you take with fluorouracil because it makes the chemotherapy more active against cancer cells. It is very unlikely you will have any side effects from it, although it occasionally causes a high temperature.

ELF is a treatment for

  • Stomach cancer
  • Food pipe cancer (oesophageal cancer)

The side effects associated with ELF are listed below.


How you have ELF treatment

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

You have ELF chemotherapy 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 treatment.

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.


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)
  • Feeling or being sick – this is usually well controlled with anti sickness medicines
  • Hair loss affects about 7 out of 10  people (70%)
  • Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
  • Mouth sores
  • A metallic taste when having the etoposide through a drip
  • Inflammation around the drip site if you notice any signs of redness, swelling or leaking at your drip site, tell your nurse straight away
  • Your blood pressure can drop if etoposide is given too quickly – if you feel dizzy or faint, call your nurse straight away to slow your drip down
  • Loss of appetite affects about 1 in 8 people (12%)

Occasional side effects

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

  • Women may stop having periods (amenorrhoea) but this may be temporary
  • 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
  • Brown marks may temporarily appear on the skin along the line of the vein where you have fluorouracil injected
  • Watery eyes from increased production of tears
  • Sensitivity to sunlight – don’t sit out in the sun, and do cover up or use sun block on exposed skin
  • Reddening of the skin may occur in areas where you have had radiotherapy in the past. The skin may get dry and flaky and feel sore and hot – this goes away on its own but keep affected areas out of the sun
  • Gritty eyes and blurred vision affect some people
  • Skin rashes, which may be itchy

Rare side effects

Fewer than 1 in 100 people have these.

  • An allergic reaction occurs in 1 or 2 out of every 100 people (1 to 2%) treated with etoposide. Let your treatment team know if you have chills, a high temperature (fever) or  wheezing. Also tell them if you feel dizzy or have a fast heart rate or swelling of the face
  • There is a small risk that you may get a second cancer some years after etoposide treatment
  • Permanently darker skin
  • Chest pain (angina) or a heart attack
  • Confusion or unsteadiness

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 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

On this website you can read about



Stomach cancer

Food pipe cancer (oesophageal cancer)

For general information, see our cancer drug side effects section


More information about ELF 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 www.medicines.org.uk.

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 www.mhra.gov.uk.

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Updated: 31 December 2014