Epirubicin Brand Name– Ellence
What is Epirubicin
Epirubicin is an anthracycline chemotherapy agent and is the 4′-epimer of doxorubicin.
It is indicated for the adjuvant treatment of node-positive early breast cancer. Epirubicin has a similar spectrum of activity and toxicity as doxorubicin.
In two European phase 3 trials comparing epirubicin (FEC) and doxorubicin (CAF) in combination with cyclophosphamide and fluorouracil for the treatment of breast cancer, the patients treated with epirubicin had similar response and survival rates as patients treated with doxorubicin.
Epirubicin has similar response rates to doxorubicin in early breast cancer, non-small cell and small cell lung cancer, non-Hodgkin lymphoma, ovarian cancer, gastric cancer, and nonresectable primary hepatocellular carcinoma.
While the spectrum of toxicities for epirubicin and doxorubicin are similar, the incidence of toxicity differs. At equimolar doses, epirubicin is less myelotoxic than doxorubicin.
Epirubicin is contraindicated in patients with severe persistent drug-induced myelosuppression.
In addition, epirubicin has a lower incidence of cardiotoxicity; the maximum cumulative dose is almost twice that of doxorubicin.
However, similar to other anthracyclines, cardiac monitoring is required; epirubicin is contraindicated in patients with severe myocardial insufficiency and in patients with a recent myocardial infarction or severe arrhythmias.
Epirubicin primarily undergoes biliary elimination and therefore is also contraindicated in patients with severe hepatic impairment (Child-Pugh C or serum bilirubin greater than 5 mg/dL).
Indications
- bladder cancer
- breast cancer
- gastric cancer
- hepatocellular cancer
- multiple myeloma
- ovarian cancer
- peripheral blood stem cell (PBSC) mobilization
- soft-tissue sarcoma
Side Effects
- alopecia
- alopecia
- amenorrhea
- anaphylactic shock
- anaphylactoid reactions
- anemia
- anemia
- anorexia
- AV block
- azoospermia
- bleeding
- bone marrow suppression
- bradycardia
- bundle-branch block
- cardiomyopathy
- cardiotoxicity
- chills
- conjunctivitis
- cystitis
- dehydration
- erythema
- esophagitis
- esophagitis
- fever
- flushing
- GI bleeding
- heart failure
- hot flashes
- hot flashes
- hyperuricemia
- infection
- infection
- infertility
- injection site reaction
- injection site reaction
- keratitis
- lethargy
- lethargy
- leukemia
- leukopenia
- leukopenia
- nail discoloration
- nausea
- nausea
- neutropenia
- neutropenia
- new primary malignancy
- oligospermia
- oral ulceration
- phlebitis
- photosensitivity
- premature ventricular contractions (PVCs)
- pruritus
- pulmonary embolism
- radiation recall reaction
- rash
- rash
- sinus tachycardia
- skin hyperpigmentation
- skin ulcer
- ST-T wave changes
- stomatitis
- stomatitis
- thrombocytopenia
- thrombocytopenia
- thromboembolism
- tissue necrosis
- urine discoloration
- urticaria
- ventricular tachycardia
- vomiting
- vomiting
Monitoring Parameters
- CBC with differential
- ECG
- echocardiogram
- LFTs
- multi-gated radionuclide angiography (MUGA)
- pregnancy testing
- serum calcium
- serum creatinine
- serum phosphate
- serum potassium
- serum uric acid
Contraindications
- anthracycline hypersensitivity
- bone marrow suppression
- breast-feeding
- cardiac arrhythmias
- cardiac disease
- cardiomyopathy
- cardiotoxicity
- children
- contraception requirements
- extravasation
- geriatric
- heart failure
- hepatic disease
- infants
- infertility
- intramuscular administration
- leukopenia
- male-mediated teratogenicity
- maximum cumulative lifetime dose
- myocardial infarction
- neonates
- neutropenia
- new primary malignancy
- pregnancy
- pregnancy testing
- radiation therapy
- renal failure
- renal impairment
- reproductive risk
- subcutaneous administration
- tumor lysis syndrome (TLS)
- vaccination
Interactions
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Calcium-channel blockers
- Cimetidine
- Clevidipine
- Cyclophosphamide
- Diltiazem
- Docetaxel
- Enalapril; Felodipine
- Felodipine
- Gadobenate Dimeglumine
- Isradipine
- Nicardipine
- Nifedipine
- Nimodipine
- Nisoldipine
- Paclitaxel
- Palifermin
- Penicillamine
- Perindopril; Amlodipine
- Trandolapril; Verapamil
- Trastuzumab
- Trastuzumab; Hyaluronidase
- Tuberculin Purified Protein Derivative, PPD
- Verapamil
