ECX (Epirubicin, cisplatin and capecitabine)

ECX is the name of a combination of chemotherapy drugs used to treat oesophageal (food pipe) cancer and stomach (gastric) cancer. It is made up of the drugs

• E= Epirubicin
• C= Cisplatin
• 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 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.

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

Epirubicin is a red liquid. You have it as a slow injection into your cannula or central line alongside a drip of salt water (saline). Cisplatin is a clear liquid. You have it as a drip (infusion) over 2 to 4 hours. You will have fluids by drip for a couple of hours before and after the cisplatin.

Capecitabine is a peach coloured tablet of 150mg 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.

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.

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 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 and tell your doctor or nurse 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
• A change in heart rhythm due to the effect of epirubicin on heart muscle – your heart will be checked before you start treatment and any changes will usually go back to normal after the treatment ends (although 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 is not harmful
• Cisplatin can cause kidney damage so 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, and you will have fluids through your drip before and after treatment
• Women may stop having periods (amenorrhoea) – this may be temporary
• ECX drugs may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Loss of fertility – we don’t know exactly how these drugs affect fertility so do talk with your doctor before starting treatment if having a baby is important to you

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

• Loss of appetite may occur a few days after your treatment
• Cisplatin can cause numbness or tingling in your hands or feet, which 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
• Epirubicin and capecitabine can cause watery, sore eyes
• Capecitabine can cause abdominal pain
• 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

Fewer than 1 in 100 people have these.

• 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

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

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. You should have a contact number for your nurse so that you can ring them 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.