This leaflet provides information on a course of chemotherapy called ECX. It will explain what this is and when and how it will be given. It will also tell you about common side effects that you may experience. Contact telephone numbers and details of how to obtain further information on ECX are given at the end of the leaflet.
This leaflet should be read alongside the ‘General information for patients receiving chemotherapy’ folder. If you haven’t received this folder please ask your nurse for a copy.
What is ECX chemotherapy?
ECX chemotherapy consists of three drugs:
E = Epirubicin
C = Cisplatin
X = Capecitabine (also known as Xeloda)
Why am I having ECX chemotherapy?
Your doctor has recommended ECX chemotherapy because it has been found to be effective in treating your type of cancer.
Will I need any tests before I have my chemotherapy?
You will need a series of blood tests before you start your chemotherapy. One of these blood tests helps us to check that your kidneys are working well enough to cope with the chemotherapy.
How often will I receive my chemotherapy?
For this treatment to be most effective it is given at specific time intervals. These are known as cycles. It is usual to have ECX every three weeks for six to eight cycles. Your doctor will discuss with you the exact number of cycles you will receive.
The epirubicin and cisplatin are given through a drip once every three weeks. The capecitabine is given as tablets that are taken twice a day for the whole course of treatment.
How often will I need to visit the hospital?
To receive ECX chemotherapy you will need to visit the hospital twice in every 3 week cycle.
Outpatient clinic appointment – you will have blood tests and we will check how you are feeling and discuss any problems you may have. This is so we can check how the chemotherapy is affecting you. If your blood results are satisfactory, your chemotherapy will be prescribed. This appointment is usually a few days before your chemotherapy appointment.
Chemotherapy appointment – you will spend about 7 hours in one of the day case treatment areas. Please allow an hour longer for your first visit. We will give you anti sickness medicine, fluids then your cisplatin and epirubicin chemotherapy.
Can I bring relatives and friends with me?
You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person. Treatment areas are not suitable for young children.
How should I take the capecitabine tablets?
Capecitabine tablets should be taken twice a day (9-12 hours apart), You should take the tablets within 30 minutes of finishing your meal. The tablets should be swallowed whole with a glass of water. They must not be chewed or crushed.
It is important that you wash your hands thoroughly after taking your tablets.
How many tablets will I need to take?
This varies for each person. There are 2 different strength tablets. The bigger tablets are 500mg and the smaller tablets are 150mg. You may have to take a combination of big and small tablets. The amount you need to take will be clearly marked on the boxes. Remember to check each box to see how many tablets you need to take.
What should I do if I forget to take my tablets?
Do not take the extra tablets when your treatment should have finished. It is important that even if you have missed any doses you should finish the treatment at the planned time.
What if I take too many tablets?
Please contact Velindre Cancer Centre immediately for advice. The telephone number is at the end of the leaflet.
How should I store my capecitabine tablets?
Store your tablets in their original packaging in a safe place away from children. They should be kept in a cool dry place. Any unused tablets should be returned to the hospital Pharmacy or your local chemist for safe disposal.
What are the possible side effects?
There are a number of possible side effects which can occur. The doctors, nurses and pharmacy team can give you advice or answer any questions you may have.
Unfortunately ECX chemotherapy will cause complete hair loss. Your hair will grow back when your treatment has finished. A method know as ‘scalp cooling’ or ‘cold capping’ can be used to prevent hair loss. If you would like more information about wigs or scalp cooling please speak to your nurse.
We have a leaflet that tells you more on coping with hair loss. Please ask your nurse if you would like a copy.
Nausea and vomiting are uncommon these days as we will give you anti-sickness medicines which are usually extremely effective. If you are sick more than once in 24 hours despite taking regular anti-sickness medicine, you should stop taking your capecitabine tablets and contact Velindre Cancer Centre for advice.
You are at an increased risk of picking up infections because your white blood cells which help fight infections can be reduced by this treatment.
If you develop an infection whilst your white blood cells are low, you are at risk of sepsis, this can be life threatening.
Contact Velindre Cancer Centre immediately if you develop any signs of infection, for example flu like symptoms or a temperature above 37.5°centigrade or if your temperature is below 35.5°. The telephone number is at the end of the leaflet.
You may have diarrhoea. If this occurs it is important that you drink plenty of fluids. We will give you medication to take if you get diarrhoea.
You should stop taking your capecitabine tablets and contact Velindre Cancer Centre immediately if:
You should also contact us if you have any problems with diarrhoea or an increase in bowel movements which lasts for more than 3 days.
Tiredness and fatigue
You may feel more tired than usual. It is important to listen to your body and rest if you need to, but carry out your normal activities if you feel able. Some people find it beneficial to take gentle exercise as well as rest.
Your mouth may become sore or you may notice small ulcers. Please follow the advice on caring for your mouth in the general chemotherapy leaflet. Your doctor may prescribe medication to prevent or clear any infection.
If your mouth becomes very painful or you are finding it difficult to eat and drink, stop taking your capecitabine tablets and contact Velindre Cancer Centre for advice.
Skin and tissue damage
Some chemotherapy drugs may damage the skin and surrounding area if they leak outside of your vein. This is known as extravasation. It is extremely rare but it is important that you tell us immediately if you notice any swelling, pain or burning at the site of the drip. If this occurs whilst the chemotherapy is being given, tell your nurse. If you notice pain, swelling or redness when you’re at home please contact us immediately. The telephone number is at the end of the leaflet.
Soreness to your hands and feet
You may experience mild pain, redness and swelling of your hands or feet. If this occurs we recommend using a non perfumed cream or lotion regularly. Please contact Velindre Cancer Centre if your hands or feet become painful.
Very rarely some people having this treatment experience heart problems. If you have a heart condition or you take any heart medication, please tell your doctor before you start chemotherapy.
If you do have any chest pain you should stop taking your capecitabine tablets and seek urgent medical attention. Do not start taking your capecitabine again until you have spoken to the team at Velindre.
Effect on your kidneys
Cisplatin can affect the way your kidneys work. The blood test you have before your chemotherapy will check how well your kidneys are working at the start of treatment. We will also monitor you carefully by taking regular blood tests throughout your treatment.
We always give cisplatin with plenty of fluids in the drip to reduce the effect on your kidneys. It is also important that you drink plenty of fluids for at least 2 days after each treatment. We suggest a cup or glass of fluid every hour during the day and evening.
Epirubicin will harmlessly discolour your urine red for a day after your chemotherapy. If this lasts for more than 24 hours please contact Velindre Cancer Centre for advice.
Cisplatin may damage the nerves of your hands and feet. You may experience numbness or changes in sensation such as tingling or pins and needles. Although this is very rare it is important you tell your doctor if this happens so we can modify your treatment before this becomes permanent.
Cisplatin may also damage the nerves responsible for hearing, although this is rare. If this occurs you may experience some loss of hearing which may be permanent.
Women may find that chemotherapy treatment affects their periods. They could become heavier, lighter or even stop.
It is important you do not become pregnant or father a child whilst having chemotherapy treatment as chemotherapy could damage the unborn baby.
ECX can increase your skin’s sensitivity to the sun. It is best to avoid strong sunlight, wear a hat and use a sun block.
Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects.
A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further. It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.
Blood clots can be very serious. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.
Manufacturer’s patient information leaflets
Velindre leaflets provide information about very common and commonly reported side-effects (we are unable to list all of the common side effects), for more information regarding these and the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at www.medicines.org.uk. Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from Velindre pharmacy
Contact telephone numbers
Velindre Cancer Centre 029 2061 5888
Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night. For example you should phone if you:
Pharmacy department 029 2061 5888 ext 6223
Mon – Fri 9am – 5pm for queries about your medicines
Macmillan freephone Helpline 0808 808 0000
Tenovus freephone 0808 808 1010
This information is also available in Welsh
This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.
Reviewed January 2016