Used historically as standard perioperative chemotherapy for resectable or advanced gastric and gastroesophageal junction (GEJ) adenocarcinoma before FLOT became the preferred regimen.
Components
- E = Epirubicin → anthracycline (DNA intercalation, topoisomerase II inhibition, free radical formation).
- C = Cisplatin → platinum compound, crosslinks DNA.
- F = 5-Fluorouracil (5-FU) → antimetabolite, thymidylate synthase inhibitor.
- X = Capecitabine → oral prodrug of 5-FU (substitute for 5-FU).
Thus:
- ECF = Epirubicin + Cisplatin + 5-FU
- ECX = Epirubicin + Cisplatin + Capecitabine
Typical Schedule (q3 weeks, perioperative or metastatic setting)
- Epirubicin 50 mg/m² IV day 1
- Cisplatin 60 mg/m² IV day 1
- 5-FU 200 mg/m²/day continuous infusion (21 days)
- OR Capecitabine 625–1000 mg/m² PO BID days 1–21 (for ECX)
Clinical Use
- Former standard of care for perioperative gastric/GEJ adenocarcinoma (based on the MAGIC trial, which showed survival benefit over surgery alone).
- Now largely replaced by FLOT, which improved overall survival and response rates.
Toxicities
- Epirubicin → myelosuppression, mucositis, cardiotoxicity (cumulative dose-dependent).
- Cisplatin → nephrotoxicity, ototoxicity, nausea/vomiting, neuropathy.
- 5-FU/Capecitabine → mucositis, diarrhea, hand-foot syndrome (capecitabine), myelosuppression.
Pharmacist Considerations
- Hydration & nephroprotection needed with cisplatin.
- Cardiac monitoring (LVEF) with epirubicin.
- Renal function must be assessed for cisplatin and capecitabine dosing.
- Anti-emetic prophylaxis (cisplatin is highly emetogenic).
- Drug-drug interactions (e.g., warfarin ↑ INR with capecitabine/5-FU).
Summary:
- ECF/ECX were historic perioperative gastric cancer regimens (Epirubicin + Cisplatin + 5-FU/Capecitabine).
- FLOT has now replaced them due to better efficacy and survival outcomes, though with higher toxicity requiring more supportive care.