Fluorouracil, epirubicin, cyclophosphamide

AC, Adriamycin (doxorubicin), Cytoxan (cyclophosphamide) CAF, Cytoxan (cyclophosphamide), Adriamycin (doxorubicin), 5-fluorouracil CEF, cyclophosphamide, epirubicin, 5-fluorouracil CMF, cyclophosphamide, methotrexate, 5-flourouracil FAC, 5-fluorouracil, Adriamycin (doxorubicin), cyclophosphamide FEC, 5-fluorouracil, epirubicin, cyclophosphamide TAC, Taxol (paclitaxel), Adriamycin (doxorubicin), cyclophosphamide. 

CMF Cyclophosphamide, methotrexate, fluorouracil COP Cyclophosphamide, vincristine (oncovin), prednisone FAC Fluorouracil, doxorubicin (adriamycin), cyclophosphamide FEC Fluorouracil, epirubicin, cyclophosphamide IFL Irinotecan, fluorouracil, leucovorin MP Melphalan, prednisone... 

Kluger N, Jacot W, Frouin E, Rigau V, Poujol S, Dereure O, et al. Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel a prospective study of 20 patients. Ann Oncol 2012 23(ll) 2879-84. 

Cytotoxic drugs that have been used alone and in combination as adjuvant therapy in breast cancer include doxorubicin, epirubicin, cyclophosphamide, methotrexate, fluorouracil,... 

Karlsson YA, Malmstrom PO, Hatschek T, et al. Multimodality treatment of 128 patients with locally advanced breast carcinoma in the era of mammography screening using standard polychemotherapy with 5-fluorouracil, epirubicin, and cyclophosphamide prognostic and therapeutic implications. Cancer 1998 83 936-947. 

Cytotoxic drags that have been used alone and in combination as adjuvant therapy in breast cancer include doxorubicin, epirubicin, cyclophosphamide, methotrexate, fluorouracil, paclitaxel, docetaxel, melphalan, prednisone, vinorelbine, and vincristine. The most common combination chemotherapy regimens employed in the adjuvant and metastatic setting are listed in Table 125-11. 

Bergh J, Wiklund T, Erikstein B, Lidbrink E, Lindman H, Malmstrom P, Kellokumpu-Lehtinen P, Bengtsson NO, Soderlund G, Anker G, Wist E, Ottosson S, Salminen E, Ljungman P, Holte H, Nilsson J, Blomqvist C, Wilking N Tailored fluorouracil, epirubicin, and cyclophosphamide compared with marrow-supported high-dose chemotherapy as adjuvant treatment for hi -risk breast cancer A randomised trial. Scandinavian Breast Group 9401 study. Lancet 2000 356 1384-1391. 

Kitagawa K, Kawada K, Morita S, Inada M, Mitsuma A, Sawaki M, et al. Prospective evaluation of corrected QT intervals and arrhythmias after exposure to epirubicin, cyclophosphamide, and 5-fluorouracil in women with breast cancer. Ann Oncol 2012 23(3) 743-7. 

Knoop AS, Knudsen H, Balslev E, Rasmussen BB, Overgaard J, Nielsen KV, et al. retrospective analysis of topoisomerase lla amplifications and deletions as predictive markers in primary breast cancer patients randomlyassignedtocyclophosphamide, methotrexate, andfluorouracilor cyclophosphamide, epirubicin, and fluorouracil Danish Breast Cancer Cooperative Group. J Clin Oncol 2005 23(30) 7483-90. 

Toxic megacolon occurred after five cycles of epirubicin 70 mg/m, 5-fluorouracil 500 mg/m, and oral cyclophosphamide 75 mg/m for 14 days (18). The clinical presentation included a raised erythrocyte sedimentation rate and a colonic diameter of greater than 9 cm the outcome can be fatal. 

Cardiomyopathy is the most common chemotherapy-associated cardiac toxicity. Myocardial ischemia, pericarditis, arrhythmias, miscellaneous electrocardiogram (ECG) changes, and angina occur much less frequently. The anthracyclines (da-unorubicin, doxorubicin, epirubicin, and idarubicin) have the highest consistent risk for cardiomyopathy, which is cumulative dose related. There is evidence that high-dose cyclophosphamide, mitoxantrone, and fluorouracil also pose an increased risk of cardiac damage. The concurrent use of traztuzu-mab with an anthracycline and cyclophosphamide is associated with a risk of cardiac dysfunction, but the consequences of sequential use are not yet known. 

Doxorubicin, epirubicin, and other anthracyclines, mitoxantrone, cyclophosphamide, 5-fluorouracil, capecitabine, gleevec, sunitinib Trastuzumab, interferon-a-2, interleukin-2, infliximab, etanercept... 

In a study in 8 patients, cimetidine 400 mg twice daily increased the AUC of epirubicin by 50%. At the same time the AUCs of two metabolites of epirubicin, epirubicinol and 7-deoxydoxorubicinol aglycone, increased by 41% and 357%, respectively. Liver blood flow also increased by 17%. The mechanism is unknown. More study of this interaction is needed but be aware of the possibility of cimetidine inereasing the exposure to epirubicin monitor the patient closely and adjust epirubicin dosage if needed. Cimetidine is available without a preseription in some countries so that patients may unwittingly increase the toxicity of epirubicin. Cimetidine has also increased the levels or toxicity of some other antineoplastics, see Nitrosoureas + Cimetidine , p.655, Cyclophosphamide + H2-receptor antagonists , p.626 and Fluorouracil + H2-reeeptor antagonists , p.633. 

Some evidence su ests ondansetron may modestly affect the pharmacokinetics of cyclophosphamide and cisplatin but it does not appear to affect those of carmustine. Ondansetron did not affect the in vitro activity of epirubicin, bleomycin, cisplatin or es-tramustine. Cisplatin and fluorouracil do not affect the pharmacokinetics of ondansetron. In in vitro studies granisetron potentiated the cytotoxic effects of epirubicin, had an additive effect on bleomycin and estramustine activity and appeared not to affect the metabolism of docetaxel and paclitaxel. 

Examples for good siurogate markers include an intermediate filament, which is released from apoptotic cancer cells during chemotherapy, and a collagen fragment which indicates bone decay [39-40]. Cyokeratin 18 is an efficient biomarker to measure the effect of breast cancer treatment via combination chemotherapy such as docetaxel or cyclophosphamide/epirubicin/5-fluorouracil (CEF). 

A 43-year-old woman with breast cancer and no history of seizures was scheduled to undergo chemotherapy with cyclophosphamide, 5-fluorouracil, and epirubicin and to receive antiemetic treatment with intravenous dexamethasone 8 mg and palonosetron 0.25 mg. During the fourth cycle of chemotherapy, she developed a generalized tonic-clonic seizure, which lasted 8 minutes and was followed by a period of drowsiness. She was given intravenous diazepam 10 mg and a saline infusion. Detailed investigations, including brain CT scan, did not reveal abnormalities, and she recovered completely. 

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