Epirubicin  (Ellence )  

Brand name: Ellence  

Generic name: Epirubicin  

Therapeutic Class: anthracyline antitumor antibiotic 

Availability:   Epirubicin is available by prescription only  

Dosage form:  Epirubicin is given by injection into a vein (IV injection)  

Indications:  Epirubicin is used - in combination with other cytostatics - in the adjuvant treatment of breast cancer in early stage with involvement of lymph nodes.  

Epirubicin is also indicated for the treatment of the following medical conditions:     

• stomach cancer 
• liver cancer  
• oral cancer  
• pancreatic cancer  
• ovarian cancer 
• hodgkin's Lymphoma  
• soft tissue sarcoma 
• esophageal cancer  
• non-Hodgkin lymphoma (also known as NHL or just lymphoma)
• Small cell lung cancer. 

Dosage:  The recommended dose of Epirubicin varies depending on the severity of the cancer, your age, health in general, and other medications you are taking. Your weight will also be taken in consideration in the choice of the treatment. Epirubicin is given intravenously in a hospital or in a medical center. The drug must be prepared and administered by medical specialists. In general, Epirubicin is administered at intervals of three to four weeks. Epirubicin can be taken alone or in combination with other anticancer drugs.  

Depending on the reaction of your body to the drug, your oncologist may adjust the dosage. A lower dose may be recommended if you are elderly or if your bone marrow function has been disrupted by prior chemotherapy or radiotherapy.  

Overdose:  the fact that Epirubicin is given in hospital by professionals, the risk of overdose is considerably low. Epirubicin overdose may cause serious health problems. An Epirubicin overdose can lead to: in 24 hours, myocardial degeneration; and 10 to 14 days, to severe decreased  of bone marrow activity  (myelosuppression). Heart failure can occur until months or years after the therapy. In addition, an overdose can cause gastrointestinal toxicity, mainly painful inflammation and ulceration of the mucous membranes lining the digestive tract  (mucositis). Treatment of Epirubicin overdose includes, in most cases, supportive measures such as blood transfusions and hospitalization.     

Missing dose: Epirubicin is administered in hospital; you cannot miss any dose if you respect all your doctor appointments. If for some reasons you cannot go to the hospital for the treatment, contact your oncologist before the date schedule for the injection. Do not stay home because you feel malaise; chemotherapy causes side effects in most patients.   

Contraindications : Epirubicin is contraindicated in the following conditions: 

• pregnancy/breastfeeding  
• liver failure  
• kidney failure   
• allergy to epirubicin or any of its ingredients   
• low blood counts due to bone marrow disorder  
• history of serious heart disease   
• History of treatment by epirubicin or by any anthracycline such as doxorubicin, daunorubicin, mitoxantrone or mitocyne C.  

Mechanism of action (MOA):  Epirubicin is an anthracyline antitumor antibiotic ; it slows or stops the growth of cancer cells in your body by altering their DNA structure.  

Interactions:  talk you to your doctor before taking any prescription or non prescription medications.  Some medications may affect therapeutic effects of Epirubicin, or increase the risk of developing side effects. Always consult with your doctor before taking these medicines:      

• Ganciclovir, an antiviral drug 
• Azathioprine, an immune system inhibitor  
• Barbiturates,  depressant drug that causes relaxation and sleepiness 
• Cimetidine  , a drug used to inhibit the production of acid in the stomach 
• Colchicines  , a medication used to treat pain of gouty arthritis 
• Live vaccines: BCG vaccine, yellow fever vaccine, etc.   
• Cyclophosphamide  (Cytoxan), a medication of the alkylating agent family used to treat a variety of cancers  
• Cyclophosphamide  (Cytoxan, Cytoxan, Neosar, Procytox, Revimmune), a drug used to treat several types of cancers  
• Celecoxib, a non-steroidal anti-inflammatory drug (NSAID) used in the treatment of osteoarthritis, rheumatoid arthritis, painful menstruation, colon and rectum polyps, etc.  

Side effects: while attacking cancer cells,  Epirubicin also affects normal (healthy) cells, which lead, in certain patients, to the following side effects:   

• mouth sores  
• hair loss  
• hot flashes  
• tiredness  
• decreased appetite  
• weight loss   
• diarrhea or constipation   
• Nausea and vomiting.   

If the side effects above persist for weeks, contact your oncologist. In addition, contact your doctor immediately if you experience any of these symptoms:   

• Persistent fever  
• chills  
• persistent cough   
• bloody diarrhea  
• shortness of breath or breathing difficulty  
• unusual bruising or bleeding  
• sensitivity of skin to sunlight  
• tingling in the hands or feet  
• Drying or darkening of the skin or nails.   

References: 

1 - ch.oddb.org/fr,   

2 - nlm.nih.gov