How it is administered

Epirubicin is given as an intravenous (IV) injection. It is supplied as a sterile, clear, red solution in vials containing 50 mg or 200 mg of epirubicin hydrochloride. The medication is administered directly into the vein, usually over 15–20 minutes, either as a single dose on Day 1 of each cycle or divided equally on Days 1 and 8 of each cycle. It is typically given in repeated 3- to 4-week cycles as part of combination chemotherapy regimens.

How it works

Epirubicin is an anthracycline cytotoxic agent. It works by forming a complex with DNA, inserting itself between DNA base pairs (a process called intercalation), which blocks the synthesis of DNA and RNA. This action inhibits the ability of cancer cells to grow and divide. Epirubicin also triggers DNA cleavage by an enzyme called topoisomerase II, leading to cell death. Additionally, it interferes with DNA helicase activity, preventing the separation of double-stranded DNA, which further disrupts replication and transcription. The drug can also generate free radicals, which are toxic to cells. These combined actions make epirubicin effective at killing rapidly dividing cancer cells, such as those found in blood cancers and other malignancies.

Who Should take it

Epirubicin is indicated as a component of adjuvant therapy in patients with evidence of axillary node tumor involvement following resection of primary breast cancer. While its primary FDA-approved use is for breast cancer, anthracyclines like epirubicin are sometimes used off-label in the treatment of certain blood cancers, such as lymphomas and leukemias, due to their ability to target rapidly dividing cells. Patients who have undergone surgery for breast cancer and have cancer involvement in the lymph nodes may benefit from epirubicin as part of a combination chemotherapy regimen to reduce the risk of cancer recurrence.

Who should not take it

Epirubicin should not be used in patients with:

• Severe myocardial insufficiency (serious heart problems)
• Recent heart attack or severe arrhythmias
• Previous treatment with the maximum cumulative dose of anthracyclines
• Severe persistent drug-induced myelosuppression (bone marrow suppression)
• Severe hepatic impairment (liver problems)
• Severe hypersensitivity to epirubicin, other anthracyclines, or anthracenediones

Patients with these conditions are at increased risk for serious complications, including heart failure, severe infections, or liver toxicity. It is also not recommended during pregnancy, especially in the first trimester, due to the risk of harm to the fetus.

Commonly used with

Epirubicin is commonly used in combination with other chemotherapy agents such as cyclophosphamide and fluorouracil (as in the CEF or FEC regimens) for breast cancer. In the context of blood cancers, anthracyclines like epirubicin may be combined with other cytotoxic drugs to enhance their effectiveness. The specific combination depends on the type of cancer being treated.

Commonly tested with

Epirubicin has been tested in combination with other cytotoxic drugs, including paclitaxel, docetaxel, cyclophosphamide, and fluorouracil. It is also sometimes 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). In clinical trials, epirubicin-based regimens are often compared with other chemotherapy combinations to assess their effectiveness and safety in cancer treatment.