Farmorubicin

Indications

Epirubicin hydrochloride is a cancer medicine used, usually with other cancer medicines, for:

• Breast cancer, including after surgery to lower the chance of it coming back.
• Stomach cancer, ovarian cancer, lung cancer, lymphomas and soft tissue sarcomas.
• Superficial bladder cancer, when it is put directly into the bladder through a tube.

It is used only by cancer specialists in hospital.

How It Works

Epirubicin belongs to the anthracycline group. It enters cancer cells and binds to their DNA, blocking an enzyme (topoisomerase II) that the cells need to copy their DNA. This stops cancer cells from growing and dividing.

Dosage and Administration

• Given by a doctor or nurse in hospital, as a drip or injection into a vein, or into the bladder through a catheter.
• The dose is worked out from your body size (body surface area), blood counts, liver function and the other treatments you are having. It is usually repeated in cycles, often every 3 weeks, as prescribed.
• There is a maximum total lifetime dose because of the risk to the heart; the team keeps track of this.
• Medicines to prevent sickness are usually given before each dose.

Interactions

• Trastuzumab and other medicines that can affect the heart, or chest radiotherapy, increase the risk of heart damage.
• Cimetidine can raise epirubicin levels and should be avoided.
• Other cancer medicines (such as Paclitaxel, Docetaxel and Cyclophosphamide) can increase effects on the blood counts and heart.
• Live vaccines must not be given during treatment.
• Tell the team about all medicines, including heart and blood pressure medicines.

Contraindications

• Allergy to epirubicin or other anthracyclines (such as Doxorubicin).
• Severe bone marrow suppression (very low blood counts).
• Severe liver impairment.
• Serious heart disease, such as severe heart failure, a recent heart attack or serious rhythm problems.
• Having already received the maximum total dose of epirubicin or other anthracyclines.
• Breastfeeding.
• For bladder use: urinary infection, bladder inflammation, or problems passing a catheter.

Side Effects

Common: hair loss, nausea and vomiting, mouth sores, tiredness, loss of appetite, low blood counts (raising the risk of infection, bleeding and anaemia), missed periods and red-coloured urine for 1 to 2 days after each dose (this is harmless). Bladder use can cause burning and frequent urination.

Tell the team straight away or get urgent medical help if you have:

• Fever of 38°C or more, chills, or other signs of infection.
• Pain, burning, redness or swelling where the drip goes in during or after the infusion.
• Shortness of breath, swollen ankles, chest pain, or a fast or irregular heartbeat.
• Unusual bleeding or bruising.
• Swelling of the face or throat, rash or difficulty breathing during the infusion.

Heart damage can appear months or years later, and rarely a second cancer of the blood (leukaemia) can develop.

Pregnancy and Lactation

Epirubicin can harm an unborn baby. Women and men should use effective contraception during treatment and for several months after (the team will advise how long). Do not breastfeed during treatment. It can affect fertility in both men and women; discuss this before treatment starts.

Precautions and Warnings

• Heart function is checked (for example, with an echocardiogram) before and during treatment.
• Blood counts, liver and kidney function are checked before each cycle.
• Avoid contact with people who have infections and report any fever quickly.
• Older people and those with previous heart problems or chest radiotherapy need extra care.

Overdose

Because it is given in hospital, overdose is unlikely. It would cause severe low blood counts, mouth sores and heart problems, and would be managed by the medical team.

Therapeutic Class

Anticancer medicine; anthracycline (cytotoxic antibiotic).

Storage

Kept by the hospital or pharmacy. The solution is stored in a fridge at 2 to 8°C, protected from light, and must not be frozen; powder forms are stored as directed on the pack. Keep out of the reach of children.