A perioperative or palliative chemotherapy regimen for gastric and gastroesophageal junction (GEJ) adenocarcinoma. It was considered the standard of care before being replaced by FLOT.
Components
- E = Epirubicin → anthracycline (DNA intercalation, topoisomerase II inhibition, free radicals).
- C = Cisplatin → platinum agent (DNA crosslinking).
- F = 5-Fluorouracil (5-FU) → antimetabolite, inhibits thymidylate synthase → impaired DNA synthesis.
Typical Schedule (every 3 weeks)
- Epirubicin 50 mg/m² IV day 1
- Cisplatin 60 mg/m² IV day 1
- 5-FU 200 mg/m²/day continuous IV infusion days 1–21
(Usually given 6–8 cycles total, perioperative setting = 3 cycles before and 3 cycles after surgery).
Clinical Use
- Based on the MAGIC trial, perioperative ECF improved survival vs surgery alone in gastric/GEJ adenocarcinoma.
- Now outdated and largely replaced by FLOT due to superior outcomes.
Key Toxicities
- Epirubicin → myelosuppression, alopecia, mucositis, cardiotoxicity (cumulative dose-dependent).
- Cisplatin → nephrotoxicity, ototoxicity, peripheral neuropathy, severe nausea/vomiting.
- 5-FU → mucositis, diarrhea, myelosuppression, cardiotoxicity (rare angina/vasospasm).
Pharmacist Considerations
- Cardiac monitoring (LVEF, baseline and cumulative epirubicin dose).
- Renal protection (pre- and post-hydration, antiemetics for cisplatin).
- Monitor for hand-foot syndrome, diarrhea, mucositis (from 5-FU).
- Drug interactions: warfarin (↑ INR with 5-FU), nephrotoxic drugs with cisplatin.
Summary:
ECF = Epirubicin + Cisplatin + 5-FU, formerly standard perioperative gastric/GEJ regimen, now replaced by FLOT due to improved survival and tolerability profile.
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