Common brand names

• Ellence

How it is administered

Epirubicin is administered as an intravenous (IV) injection. It is supplied as a sterile, ready-to-use solution in vials containing either 50 mg or 200 mg of epirubicin hydrochloride. The medication is given through a vein, usually over 15–20 minutes, and can be administered as a single dose on Day 1 of each treatment cycle or divided equally and given on Days 1 and 8 of each cycle. The cycles are typically repeated every 3 to 4 weeks. Epirubicin should not be mixed with other drugs in the same syringe and should always be administered into the tubing of a freely flowing IV infusion to minimize the risk of tissue damage.

How it works

Epirubicin is a type of chemotherapy known as an anthracycline topoisomerase inhibitor. It works by interfering with the DNA inside cancer cells. Specifically, epirubicin intercalates (inserts itself) between DNA base pairs, which blocks the synthesis of DNA and RNA, and inhibits the enzymes needed for cell replication and repair, such as topoisomerase II and DNA helicase. This disruption leads to DNA breaks and prevents the cancer cells from dividing and growing, ultimately causing their death.

Epirubicin also generates free radicals, which can damage cell components, further contributing to its ability to kill cancer cells. While it is cytotoxic to many types of cells, cancer cells are particularly sensitive because they divide rapidly. The medication is widely distributed in the body after IV administration and is mainly eliminated through the liver and bile.

Who should take it

Epirubicin is indicated as a component of adjuvant therapy for patients with breast cancer who have evidence of cancer in the axillary lymph nodes following surgical removal of the primary tumor. While it is not specifically approved for B-Cell Prolymphocytic Leukemia (B-PLL), it is sometimes used off-label for various blood cancers due to its broad anti-cancer activity.

Patients who are prescribed epirubicin typically have aggressive or high-risk cancers where chemotherapy is needed to reduce the risk of recurrence or to shrink tumors. The decision to use epirubicin should be made by an oncologist based on the specific type of cancer, stage, and overall health of the patient.

Who should not take it

Epirubicin should not be used in patients with:

• Severe heart problems, such as recent heart attack, severe heart failure, or serious arrhythmias.
• Previous treatment with the maximum cumulative dose of anthracyclines (due to increased risk of heart damage).
• Severe, persistent drug-induced bone marrow suppression (myelosuppression).
• Severe liver impairment (high bilirubin levels or Child-Pugh Class C).
• Severe hypersensitivity to epirubicin, other anthracyclines, or anthracenediones.

It should also be avoided during the first trimester of pregnancy due to the risk of harm to the fetus. Patients with active infections or those who are immunocompromised should be carefully evaluated before starting treatment.

Commonly used with

Epirubicin is often used in combination with other chemotherapy drugs, especially cyclophosphamide and fluorouracil, as part of combination regimens for breast cancer and sometimes for other cancers. These combinations can enhance the effectiveness of treatment but may also increase the risk of side effects.

It may also be used alongside supportive medications such as antiemetics (to prevent nausea and vomiting) and antibiotics (to prevent infection during periods of low white blood cell counts).

Commonly tested with

Epirubicin has been tested in combination with other cytotoxic drugs, such as cyclophosphamide, fluorouracil, paclitaxel, and docetaxel in clinical trials. These studies aim to determine the most effective regimens and to monitor for additive toxicities, particularly effects on the bone marrow and gastrointestinal system.

It is also sometimes tested with radiation therapy, but care is taken to avoid overlapping toxicities. Cardiac function is closely monitored when epirubicin is used with other drugs that may affect the heart.