II. Indications

  1. FDA Approved
    1. Breast Cancer (primary cancer, adjuvant therapy)
  2. Off-Label
    1. Esophageal Cancer
    2. Gastric Cancer
    3. Osteosarcoma
    4. Soft Tissue Sarcoma

III. Mechanism

  1. See Antibiotic Chemotherapy
  2. Epirubicin is an Anthracycline aminoglycoside Antineoplastic Agent
    1. Epirubicin is the 4'-epi-isomer of Doxorubicin
  3. Epirubicin (like Doxorubicin) inserts between adjacent DNA base pairs
    1. Blocks DNA Transcription by RNA Polymerase
  4. Epirubicin (like Doxorubicin) also inhibits Topoisomerase 2
    1. Inhibits normal Nucleotide strand ligation during DNA Replication
  5. Epirubicin (like Doxorubicin) also induces free radical formation with several secondary effects
    1. Lipid peroxidation of cell membrane lipids (cytotoxic effects)
    2. Toxic effects (esp. cardiovascular adverse effects)

IV. Medications

  1. Epirubicin IV solution: 2 mg/ml in 100 ml vial

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Adverse Effects

  1. Severe skin and soft tissue necrosis on extravasation
    1. Epirubicin is a strong Vesicant (causes Blistering)
  2. Carcinogenic
    1. Risk of secondary malignancy (esp. Acute Myelogenous Leukemia)
  3. Cardiotoxicity (esp. children)
    1. Risk of Congestive Heart Failure (esp. with multiple doses)
  4. Myelosuppression
  5. Hyperuricemia
  6. Alopecia
  7. Impaired future fertility
  8. Urine Discoloration (transient red coloration)

VII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Liver Function Tests
    3. Renal Function Tests
    4. Serum Uric Acid
    5. Echocardiogram with ejection fraction

VIII. Drug Interactions

  1. Cimetidine
    1. Increases Epirubicin levels

X. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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