epirubicin
Epirubicin (Ellence) is a type of chemotherapy used along with other anticancer medications to get rid of remaining cancer in the armpit region after the breast cancer tumor has been removed by surgery. Epirubicin (Ellence) is given as an injection through your veins, typically once during every 3- or 4-week treatment cycle. This medication commonly causes hair loss, nausea, and vomiting.
What is Epirubicin (Ellence)?
What is Epirubicin (Ellence) used for?
- Remaining cancer in the armpit region (axillary node tumor) after removal of primary breast cancer tumor
How Epirubicin (Ellence) works
Epirubicin (Ellence) is a type of chemotherapy. Specifically, it’s called a topoisomerase II inhibitor. It works by blocking your cells from repairing and making copies of its genetic material. This prevents the cancer cells from growing and causes them to die.
Drug facts
Side effects of Epirubicin (Ellence)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Hair loss (up to 96%)
- Nausea/vomiting (up to 92%)
- Low blood cell counts (up to 80%)
- Missing menstrual cycles (amenorrhea) (up to 72%)
- Painful sores inside of mouth and throat (up to 59%)
- Lower energy levels (up to 46%)
- Hot flashes (up to 39%)
- Diarrhea (up to 25%)
- Infection (up to 22%)
Please note: These side effects were reported by people in clinical trials who took epirubicin (Ellence) with cyclophosphamide (Cytoxan) and fluorouracil.
Less Common Side Effects
- Pink eye or eye inflammation
- Rash, itchy skin, or other changes in your skin
- Fever with or without low white blood cell counts
- Loss of appetite
Epirubicin (Ellence) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Blood clot in lungs: difficulty breathing, chest pain, coughing up blood
- Heart problems: chest pain, changes in heartbeat, sudden weight gain, trouble breathing, dizziness, feeling light-headed
- Tumor lysis syndrome: nausea, vomiting, feeling tired, pounding heart, muscle cramps, feeling numb, not feeling hungry, seizures, seeing things that aren’t really there
The following Epirubicin (Ellence) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Black, tarry stools
bleeding, redness, or ulcers in the mouth or throat
cough or hoarseness
fever or chills
lower back or side pain
pain or burning in the mouth or throat
painful or difficult urination
sores, ulcers, or white spots in the mouth or on the lips
swollen glands
trouble breathing
unusual bleeding or bruising
unusual tiredness or weakness
Less common
Blood in the urine or stools
pinpoint red spots on the skin
red streaks along the injected vein
Get emergency help immediately if any of the following symptoms of overdose occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Absent, missed, or irregular menstrual periods
burning, dry, or itching eyes
discharge or excessive tearing
feeling of warmth
hair loss or thinning of the hair
redness of the face, neck, arms, and occasionally, upper chest
redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
stopping of menstrual bleeding
sudden sweating
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
Rare
Darkening of the soles, palms, or nails
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Epirubicin (Ellence)
Pros
- Available as a lower-cost generic
- Given once (sometimes twice) during every 3- or 4-week treatment cycle
- It can be infused over a short amount of time (15 to 20 minutes)
Cons
- Need to get regular heart monitoring because can cause heart problems
- Put you at higher risk for serious infections
- Must be given healthcare provider, typically at an infusion center
Pharmacist tips for Epirubicin (Ellence)
- Receiving epirubicin (Ellence) treatment can make it harder for your body to fight off infections because it weakens your immune system. You shouldn’t receive any live vaccines during this time because doing so can cause you to become seriously sick. Before you receive any vaccinations, let your provider or pharmacist know that you’re being treated with epirubicin (Ellence).
- Let your provider know right away if you feel pain at the infusion site after they start the epirubicin (Ellence) infusion. This medication can cause burning pain and irritation to your veins or the skin area around the infusion site. If you experience this, your provider will stop the infusion and treat your skin with ice to ease the pain. Your provider might also give you other medications, such as dexrazoxane (Totect), to ease the irritation.
- If you experience pain at the infusion site, your provider will likely ask you to continue icing that site for 3 days after your infusion. You should ice that area 4 times a day, for 15 minutes at a time.
- If you need medication for heartburn while receiving epirubicin (Ellence) treatment, ask your provider what is a safe medication for you. Don’t take cimetidine (Tagamet HB) with epirubicin (Ellence) because this medication can raise the levels of epirubicin (Ellence) in your body and put you at higher risk for side effects.
- Your urine might look red for 1-2 days after your epirubicin (Ellence) infusion. This is normal and not harmful. This happens because the medication itself is a red color.
- If you’ve had radiation in the past, receiving epirubicin (Ellence) might cause a reaction called radiation recall, sometimes even years after your radiation. This is an inflammatory reaction that affects the areas of the body where you previously received radiation. Let your provider know if you develop blisters or skin peeling, or it looks like you have a severe sunburn. These can be symptoms of radiation recall.
- Epirubicin (Ellence) can cause heart failure, which happens when your heart can't pump blood the way it should. Let your provider know right away if you experience signs of heart problems, such as trouble breathing, swelling of your ankles or feet, sudden weight gain, fast heartbeat, or pounding in your chest.
Common questions about Epirubicin (Ellence)
Epirubicin (Ellence) is only FDA-approved to treat the cancer that remains in and around the armpit region after breast cancer surgery. But, the National Comprehensive Cancer Network (NCCN) guidelines do list it as one of the preferred options for high-risk triple negative breast cancer as well (when it’s used alongside other medications). Talk with your provider if you’ve any questions about whether epirubicin (Ellence) is an appropriate treatment for you.
In clinical trials, nearly all people treated with epirubicin (Ellence) experienced nausea and vomiting. If you've nausea and vomiting during your treatment, let your provider know. They can prescribe anti-nausea medications, such as ondansetron (Zofran), to help ease these symptoms. Your provider can also recommend tips to lower your risk and severity of nausea and vomiting without medication. Ways to do so include eating smaller meals, staying hydrated, avoiding smells that can trigger nausea, and getting fresh air. Keep track of when you experience nausea and vomiting and let your provider know so they can create a personalized plan to ease your symptoms.
Yes, people who receive epirubicin (Ellence) often experience hair loss. This side effect is temporary and hair typically begins to grow back about 3 months after the treatment is finished. You can try to lessen hair loss by using a cooling cap. This works to reduce blood flow to your scalp, which means lower amounts of the drug can reach this area. You can also lessen hair loss by minimizing or avoiding certain hair care activities, such as brushing too often, hair dying, or applying heat to hair. Talk with your provider if you’re concerned about hair loss with epirubicin (Ellence).
Based on animal studies, it’s possible for epirubicin (Ellence) to pass into breast milk. Because of the risk of harm to breastfed babies, you shouldn’t nurse during epirubicin (Ellence) treatment or for at least a week after your last dose. Talk with your provider if you have any questions about breastfeeding and epirubicin (Ellence) or other ways to feed your baby during treatment.
Maybe. How well your kidneys and liver work can affect how well your body gets rid of epirubicin (Ellence). If your kidneys or liver aren't working very well, the medication might stay in your body longer and you might be at higher risk for developing side effects. Let your provider know your full medical history. They’ll use this information, in combination with results from lab work, to determine how well your kidneys and liver are working. If your kidney or liver problems are serious enough, your provider might lower your dose of epirubicin (Ellence) or recommend a different treatment option for you.
Epirubicin (Ellence) can affect the menstrual cycle and lead to problems such as ammenorrhea or premature menopause. These conditions can affect your ability to have a child. Depending on your age at treatment, these effects on the menstrual cycle can be permanent. If you plan to have children, talk with your provider about the benefits and risks of receiving epirubicin (Ellence) before you start treatment.
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Risks and warnings for Epirubicin (Ellence)
Epirubicin (Ellence) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart damage
- Risk factors: Heart problems | Radiation to chest area | Taking other heart-damaging anticancer medications | Receiving more cycles of epirubicin (Ellence)
Epirubicin (Ellence) can cause various heart problems, including changes to your heartbeat and heart rhythm, as well as heart failure. These problems can happen early on in your treatment or they can show up months or years after you stop treatment. Your risk for heart problems goes up the more rounds of treatment you have with epirubicin (Ellence). Your provider will put a cap to the total life-time dose of epirubicin (Ellence) you can receive to try to lower your risk of heart problems. Your provider will also monitor your heart before you start epirubicin (Ellence) and regularly throughout your treatment to look for any problems. Let your care team know if you experience any signs and symptoms of heart damage, including trouble breathing, dizziness or lightheadedness, irregular heartbeats, chest pain, or weight gain.
Risk for blood cancers
- Risk factors: Receiving epirubicin (Ellence) or similar medications for a long time
Though rare, people who received epirubicin (Ellence) have developed blood cancers. Typically, these cancers occur within 1 to 3 years of epirubicin (Ellence) treatment. And the risk for developing blood cancers go up the longer a person receives epirubicin (Ellence). Let your provider know right away if you experience possible symptoms of blood cancer, such as feeling unusually tired and weak, getting infections more often, bruising and bleeding easily, bone pain, fever, unexplained weight loss, or night sweats.
Severe damage to skin tissue
- Risk factors: Faster than recommended infusion rates | Repeated injections into the same vein
Epirubicin (Ellence) can sometimes cause skin damage to areas near the infusion site and lead to symptoms such as burning, stinging, and pain. This happens when some of the medication leaks out of the infusion area (extravasation) or causes damage to the vein. If you have extravasation, your provider will stop your infusions. They’ll try to ease your pain by having you apply ice packs to the infusion site or administer other medications, like dexrazoxane Totect, to treat the problem. Depending on how severe your condition is, your provider might be able to restart epirubicin (Ellence).
Severely low blood cell counts
Epirubicin (Ellence) can cause your red blood cell, white blood cell, and platelet counts to drop. When your blood cell counts drop too low, you’re at risk for problems such as infection, anemia, and bleeding or bruising. Your provider will frequently monitor your blood cells through lab work. If your blood cell counts drop too low, your provider might need to pause your treatment or lower your dose. Let your provider know right away if you experience symptoms of low blood cell counts, such as:
- Anemia (from low red blood cells): headache, tiredness, feeling irritable, pale skin, brittle nails, trouble breathing
- Infections (from low white blood cells): fever, headache, chills, sore throat, body aches, tiredness, cough, difficulty breathing
- Bleeds (from low platelets): bruising easily, bleeds that are difficult to stop, vomiting blood, tarry stool (from stomach bleeds)
High uric acid and electrolyte imbalances (Tumor lysis syndrome)
- Risk factors: Fast-growing cancer | Not drinking enough fluids | Kidney problems
Some people receiving epirubicin (Ellence) might experience tumor lysis syndrome (TLS), which can then lead to organ damage. TLS happens when cancer cells rapidly die and release their contents into the blood. It typically occurs within the first week of epirubicin (Ellence) treatment. Your provider will monitor your lab work for signs of TLS, which can include higher levels of uric acid, potassium, calcium, and phosphate. Let your provider know right away if you develop any symptoms of TLS, such as dark urine, a racing heart, muscle cramps or spasms, numbness, nausea, or vomiting.
Blood clots
Though rare, epirubicin (Ellence) can cause blood clots, including those in the lungs. Sometimes, these clots can be life-threatening. Symptoms of blood clots can differ depending on where your blood clot is located. Let your provider know right away if you experience dizziness, chest pain, feeling faint, or trouble breathing.
Liver and kidney problems
Your provider will check you liver and kidney health before you start and throughout treatment with Epirubicin (Ellence). If you have liver damage, you’re likely to experience more side effects from this medication, so your provider might lower your dose. And if you have kidney damage, your provider might also adjust your dose of epirubicin (Ellence).
Harm to unborn baby
Based on animal studies, epirubicin (Ellence) can cause harm to an unborn baby if taken by mothers during pregnancy. If you're able to become pregnant, you should use birth control while you’re receiving epirubicin (Ellence) and for at least 6 months after your last dose. Your provider might ask you to take a pregnancy test before you start treatment to make sure you’re not pregnant.
Males with partners who are able to become pregnant should use birth control while receiving epirubicin (Ellence) and for at least 3 months after your last dose. And if your partner is already pregnant, you should use condoms while receiving this medication and for at least a week after your last dose.
Let your provider know right away if you or your partner become pregnant during this time.
Epirubicin (Ellence) dosage
Typical dosage for Epirubicin (Ellence)
Epirubicin (Ellence) is given by a healthcare provider as an injection into the vein (IV). Your provider will calculate your dose of epirubicin (Ellence) based on your body surface area (BSA, in units of m2), which takes into account your body weight and height.
- The typical dose of epirubicin (Ellence) is 100 to 120 mg/m2 injected once on Day 1 (or divided into 2 doses and given on Day 1 and 8) of every 3- or 4-week treatment cycle.
Your dose of epirubicin (Ellence) and the length of time of each treatment cycle depends on what other anticancer medications your provider is prescribing as part of your treatment. Typically, you'll receive 6 cycles of treatment with epirubicin (Ellence).
Interactions between Epirubicin (Ellence) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Tasonermin
- Varicella Virus Vaccine, Live
- Zoster Vaccine, Live
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Adenovirus Vaccine
- Amlodipine
- Aranidipine
- Bacillus of Calmette and Guerin Vaccine, Live
- Bepridil
- Cholera Vaccine, Live
- Cilnidipine
- Clevidipine
- Dengue Tetravalent Vaccine, Live
- Diltiazem
- Felodipine
- Influenza Virus Vaccine, Live
- Isradipine
- Manidipine
- Margetuximab
- Nicardipine
- Nifedipine
- Nimodipine
- Nisoldipine
- Nitrendipine
- Pertuzumab
- Poliovirus Vaccine, Live
- Smallpox Vaccine
- Trastuzumab
- Typhoid Vaccine, Live
- Verapamil
- Yellow Fever Vaccine
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Epirubicin (Ellence) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Epirubicin (Ellence) will not be safe for you to take.
- Severe heart problems
- Recent heart attack or severe change in heart rhythm
- Previous use of chemotherapy (anthracyclines) that can cause heart damage
- Severely low red blood cells, white blood cells, and platelets caused by other medications
- Severe liver damage
- Past serious allergic reaction to certain other anticancer medications (anthracyclines or anthracenediones)
What are alternatives to Epirubicin (Ellence)?
