ECF

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

• Epirubicin
• Cisplatin
• Fluorouracil (5FU)

It is used to treat stomach cancer and cancer of the food pipe (oesophagus). Click on the links above to find out the side effects of each individual drug. The side effects of a combination of drugs are usually a mixture of the side effects of the individual drugs. The combination of drugs may increase or decrease your chance of getting each side effect. Or it may change the severity. Sometimes the 5FU (given as a drip) is replaced by capecitabine (Xeloda) that is taken as tablets. Then the combination is called ECX.

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) going 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 click on search at the top of the page.

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

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

• 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, 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 treatment centre 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 (tiredness) 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 is usually well controlled with anti sickness tablets or injections. If sickness happens, it usually starts a few hours after each treatment and last for about a day. If your sickness is not controlled tell your doctor or nurse as 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 is not harmful
• 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 and if it is severe or continues, tell your doctor or nurse
• A sore mouth or mouth ulcers
• ECF may have a harmful effect on a developing baby – it is not advisable to become pregnant or father a child if you are having these drugs. You should talk about contraception with your doctor or nurse before having the treatment
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with these drugs. If you haven’t had your menopause, your periods will probably stop. Talk to your doctor before starting treatment if having a baby is important to you
• Skin changes may occur, including rashes (which may be itchy), darker skin, sensitivity to sunlight, and 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 and you will be given fluids into your vein before and after your treatment

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

• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Allergic reactions can happen while you are having the ECF treatment – you will be monitored for signs of allergic reaction. Tell your nurse if you feel hot or shivery or if you have skin rashes and itching, redness of the face, a feeling of dizziness, headaches, shortness of breath, anxiety, or a need to pass urine
• Nails may become darker and may have white lines on them
• Sore eyes
• Sensitivity of the skin to sunlight – don’t sit out in the sun. Remember to cover up or use sun block on exposed skin
• Increased production of tears
• 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 affects 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. 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

Fewer than 1 in 100 people have these.

• 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

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

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

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

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines 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.

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.