ECarboX

EcarboX is the name of a combination of chemotherapy drugs used to treat some types of advanced cancer, including oesophageal cancer, stomach cancer and ovarian cancer. It is made up of the drugs

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

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

The side effects of a combination of drugs are usually a mixture of those of each drug. You may get some or all of the side effects. The combination may increase or decrease your chance of getting each side effect or it may change the severity. 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.

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. You have the tube put in just before your course of treatment starts and it stays in as long as you need it.

Capecitabine comes as peach coloured tablets. 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 the tablets. It is important to wash your hands well after taking them. Store them out of the reach of children.

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 the 21 days in the cycle.

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.

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

Temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery.
• 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).

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• 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 drugs
• 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 but is usually well controlled with anti diarrhoea medicines – drink plenty of fluid and tell your doctor 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) which may cause tingling, numbness, pain and dryness
• Damage to heart muscle from epirubicin, which is usually temporary but for a small number of people 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) – this may be temporary
• Loss of fertility – we don’t know exactly how these drugs affect fertility so do talk with your doctor before starting treatment if this is important to you
• These drugs may have a harmful effect on a developing baby – do talk to your doctor before having treatment if there is any chance that you or your partner could become pregnant

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

• Loss of appetite
• A loss of taste or a metallic taste
• Carboplatin may affect your ability to hear some high pitched sounds but this usually gradually gets better after the treatment
• Numbness or tingling in fingers and toes affects about 4 out of 100 people (4%) who have carboplatin – it can cause difficulty with fiddly things such as doing up buttons. This starts within a few days or weeks and usually goes within a few months of finishing treatment
• Nails may become darker or have white lines on them but this grows out a few months after the end of treatment
• Watery and sore eyes can occur with epirubicin and capecitabine
• Capecitabine can cause abdominal pain
• Constipation sometimes affects people who take capecitabine but this is generally well controlled with laxatives
• Higher levels of bilirubin in your blood – you will have blood tests during and after treatment

Fewer than 1 in 100 people have these.

• There is a small risk that you may get a second cancer some years after EcarboX treatment
• Swelling of the ankles and chest pain can occur with capecitabine
• Some people have an allergic reaction while having carboplatin treatment, usually at the first or second treatment – let your nurse know immediately if you have any skin rashes, itching, shivering, a red face, headache, shortness of breath, anxiety, feel dizzy or hot, or suddenly need to pass urine
• About 1 in 100 people (1%) have ringing in their ears (tinnitus)

You may get 1 or 2 or a few of the above side effects. 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

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

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

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 and yellow fever. 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 for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.