ELF

ELF is the name of a combination of chemotherapy drugs used to treat stomach cancer or oesophageal cancer. It is made up of the drugs

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

The underlined links above take you to more 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.

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 ELF 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.

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

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.

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

• Feeling or being sick – this is usually well controlled with anti sickness drugs
• Hair loss affects about 7 out of 10 (70%) people treated with etoposide
• Diarrhoea – drink plenty of fluid and tell your doctor 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 chemotherapy nurse immediately
• 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%) having etoposide
• This drug may have a harmful effect on a developing baby – do talk to your doctor about contraception 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.

• Women may stop having periods (amenorrhoea) – this may be temporary
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if this is important to you
• 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
• Gritty eyes and blurred vision affect some people
• Sensitivity to sunlight after fluorouracil – don’t sit out in the sun, and 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, and 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
• Skin rashes, which may be itchy

Fewer than 1 in 100 people have these.

• An allergic reaction in 1 or 2 out of every 100 people (1 to 2%) treated with etoposide – let your treatment team know if you have chills, fever, wheezing, a fast heart rate, drop in blood pressure 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

Not everyone will get these side effects. You may have none 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. 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.