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EOF

EOF is the name of a chemotherapy combination that includes:

  • epirubicin
  • oxaliplatin
  • fluorouracil (5FU)

It is a treatment for stomach, oesophageal and gastro oesophageal junction (GOJ) cancer.

How EOF works

These cancer drugs destroy quickly dividing cells, such as cancer cells.

How you have EOF

You have all EOF drugs into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

You have the 5FU through a small pump. The pump slowly puts the fluid into your bloodstream (infuses). You can keep the pump in a small bag or attached it to a belt. You'll need to go back to the hospital every 7 days during your treatment to have the pump changed. Or sometimes a chemotherapy nurse may be able to do it for you at home.

When you have EOF

You usually have EOF chemotherapy as cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover.

Each cycle of treatment lasts 21 days (3 weeks). Depending on your needs, you may have up to 8 cycles, taking between 4 and 6 months in total.

You have each cycle of treatment in the following way:

Day 1
  • You have epirubicin as an injection into your vein.
  • You have oxaliplatin as a drip into your vein over 2 hours.
  • You have fluorouracil (5FU) as a continuous drip through a portable pump.
Day 2 to 21
  • You have fluorouracil (5FU) as a continuous drip through a portable pump (you have the pump changed on day 8 and day 15).

You then start your next cycle of treatment.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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 petechiae).

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Difficulty swallowing or breathing due to cold air

Oxaliplatin can make you more sensitive to the cold. It can affect your throat causing it to feel as though it is difficult to breathe and swallow. This can happen whilst you have oxaliplatin or within 2 hours of it finishing. It’s only temporary but can feel quite frightening.

Opening and closing the fridge or freezer, touching metal, eating or drinking cold foods and changes in temperature from the weather can trigger this.

It can help wearing gloves and avoid very cold food and drink for 24 hours before and after oxaliplatin.

Let your nurse know straight away if it's affecting your breathing and swallowing.

Allergic reaction

A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse might give you medicines beforehand to try to prevent a reaction.

Tell your nurse or doctor immediately if at any time you feel unwell. They will slow or stop your drip for a while.

Difficulty breathing or a cough

It is important to tell your doctor or nurse if you have a cough, or are breathless.

More rarely lung changes such as stiffening of the lungs can cause breathing problems too.

Eye problems

You might have eye problems, such as inflammation of the white tissue of your eye (pink eye or conjunctivitis). Symptoms include itchy, watery or gritty eyes. Or you might have inflammation of the clear, dome shaped tissue on the front of your eye (keratitis). Symptoms include pain, blurred vision, watery eyes and sensitivity to light.

Let your doctor or nurse know if you have any problems with your eyes. They can give you eye drops to help.

More rarely you might have eyes moving quickly from side to side (nystagmus), blocked tear ducts, an eyelid turning outwards, double vision or temporary loss of vision.

Hot flushes

We have some tips for coping with hot flushes and the possible treatments for men and women. Talk to your doctor if your hot flushes are hard to cope with. They might be able to prescribe you some medicines.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Sore mouth and throat and other parts of the digestive system

It may be painful to swallow drinks or food. Painkillers and mouth washes can help to reduce the soreness and keep your mouth healthy.

Other parts of the digestive system can also be affected. An inflamed food pipe (oesophagus) can cause heartburn. Inflammation of the back passage (rectum) can cause diarrhoea. Other symptoms are pain, bleeding and discharge and the feeling that you want to pass a bowel movement. Speak to your doctor or nurse if you have these symptoms.

Diarrhoea or constipation

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Skin changes

You might notice skin changes, such as dryness, itching, rashes or areas of skin which differ in appearance and are raised like bumps.

Tell your healthcare team if you have any rashes or problems with your skin and nails. They might be able to give you something to help like a cream or lotion.

Occasionally these drugs can cause your skin to get flaky and your skin might change colour. So, they might get darker or lighter. 

More rarely EOF can cause your skin to get red, crack, blister, ooze, crust and you might develop a sudden rash that’s raised, red and itchy (hives). Your skin might also be sensitive to the sun so you may burn easily. Wear a high factor sun block if you're going out in the sun.

Hair thinning and hair loss

You may have some hair loss or hair thinning. This can be upsetting. Your hair might grow back once treatment has finished.

Red or pink urine

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Periods stopping

Women might stop having periods (amenorrhoea) but this may be temporary.

Feeling generally unwell

Speak to your doctor or nurse if you feel generally unwell after taking this drug.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

5FU can cause liver cell damage, but this is rare.

Inflammation of the bladder (cystitis)

Inflammation of the bladder causes a burning feeling when passing urine and the need to pass urine often. Tell your doctor or nurse if you have this and try to drink plenty of fluids.

Occasionally you might have blood in your urine.

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

High blood sugar levels

High blood sugar levels can cause headaches, feeling thirsty and blurred vision. You have regular tests to check your blood sugar levels. You may need to check your levels more often if you are diabetic.

Changes to the levels of minerals in your blood

You may have changes in levels of minerals and salts in your blood, such as low potassium and high sodium. You have regular blood tests during treatment to check this.

Occasionally you might have low levels of calcium in the blood. You have regular blood tests to check this.

Numbness or tingling in fingers or toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually goes back to normal a few weeks after your treatment finishes.

Headaches

Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.

Tummy (abdominal) cramps

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Occasionally you might have inflammation of the lining of the stomach or a stomach ulcer.

Back pain

You might have back pain. Speak to your doctor if this is a problem for you. They can prescribe medicine to help. 

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

High levels of enzymes in the blood

You might have higher than usual levels of an enzyme called blood lactate dehydrogenase in your blood. Body tissues release blood lactate dehydrogenase when damaged.

Weight changes

You may gain weight while having this treatment. You may be able to control it with diet and exercise. Tell your doctor or nurse if you are finding it difficult to control your weight. 

Less commonly you might lose weight.  

Raised uric acid levels in the blood

High levels of uric acid in your blood can lead to a build up of crystals in body tissues and cause inflamed joints. You’ll have regular blood tests to check your levels. Drinking plenty of fluids helps to flush out the excess uric acid. You might also have medicines to control the uric acid levels.

Changes in how your heart works

You may have changes to how your heart works. This can cause changes to your heart rhythm and how well it is able to pump blood around your body. Symptoms that your heart is not working properly might include breathlessness when resting or after an activity; feeling tired and lacking energy most of the time and swollen ankles and legs.

Your doctor might ask you to have tests to check your heart, such as an electrocardiogram (ECG).

Occasionally people experience chest pain when the heart muscle does not get the blood it needs.

It is rare but these drugs can cause other side effects like a heart attack, lack of oxygen to the heart, inflammation of the heart muscle, an enlarged heart muscle or a heart not being able to pump enough blood (cardiac shock).

Soreness, redness and peeling on palms and soles of feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your doctor or nurse will tell you what moisturiser to use.

Slow wound healing

Any wounds you might have can take longer to heal. Keep wounds clean to prevent infection. Contact your GP or specialist nurse if you are worried about a wound.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

  • not enough fluid in your body (dehydration) – make sure you drink plenty of fluids
  • reddening (flushing) of the skin
  • brittle, chipped and ridged nails that change colour, more rarely you might have thickening of the nail bed, inflammation, pain and changes in the colour of the nail bed
  • mood changes - you might be depressed tell your doctor or nurse if you are
  • sleep changes - you might find it more difficult to get to sleep or you might sleep more than usual
  • dizziness
  • damage to the nerves that control your muscles causing weakness, cramping or twitching
  • inflammation of the membranes covering the brain and spinal cord (meninges) causing symptoms similar to meningitis (stiff neck, unable to look at bright light and headache)
  • blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms
  • a high blood pressure - tell your doctor or nurse if you have headaches or changes to your eyesight, your blood pressure is checked regularly while having this drug
  • hiccups
  • indigestion and heartburn - ask your doctor or nurse for anti heartburn medicines if you need them
  • bleeding from your gut or back passage (rectum)
  • an increase in sweating
  • joint and bone pain
  • high levels of a waste chemical called creatinine in your blood – you will have regular blood tests to check this
  • a risk of falls

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

  • a second cancer - there is a small risk that you may get certain types of blood cancer. Your doctor will discuss this with you
  • a blood disorder that causes your red blood cells to be destroyed faster than they can be made. You might have symptoms such as feeling tired, dizzy, headache and confusion
  • an imbalance of chemicals in your body that affects the pH of the blood
  • feeling nervous
  • feeling confused and disorientated, and having problems with walking or speaking due to changes in the brain
  • hearing changes such as loss of hearing
  • slowing down or blockage of your gut
  • shaking and trembling, stiffness and slow movement (symptoms of Parkinson's disease)
  • an increase in the muscle tone of your legs and feet causing them to be stiff
  • feeling very happy (euphoria)
  • seizures (fits) or coma
  • low blood pressure
  • a lack of blood flow to the brain, bowel, arms, legs and skin

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Low DPD levels don’t cause symptoms so you won’t know if you have a deficiency. You should have a test before you start this treatment to check if you have a DPD deficiency. 

Some people have severe side effects from capecitabine or fluorouracil even if they don't have low DPD levels. Contact your doctor or nurse if your side effects are severe.

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Phenytoin

Fluorouracil can raise the levels of phenytoin in your blood. You should have regular blood tests to prevent this from happening.

Sodium

This drug contains sodium (salt). You might need to take account of this if you are on a controlled sodium diet. Tell your doctor if you are on a low salt diet.

Pregnancy and contraception

This treatment 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 at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with these drugs for at least 6 months. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.  

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
02 Oct 2020
Next review due: 
02 Oct 2023
  • Electronic Medicines Compendium

    Accessed July 2020

  • Handbook of Cancer Chemotherapy (8th edition)
    Roland K Keel
    Lippincott Williams and Wilkins, 2012

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF

    K Sumpter and others

    British Journal of Cancer, 2005. Vol 92, Pages 1976-1983

  • Capecitabine and Oxaliplatin for Advanced Esophagogastric Cancer
    D Cunningham and others
    The New England Journal of Medicine, 2008. Vol 358, Pages 36-46