Cancer drugs A to Z list
EOX is a chemotherapy drug combination. You have:
E – epirubicin (epee-roob-i-sin)
O – oxaliplatin (ox-al-e-plait-in)
X – capecitabine (cap-site-a-been). It is also known as Xeloda. This is the oral form of 5-fluorouracil.
You might have it as a treatment for oesophageal or stomach cancer.
Find out more about your cancer type
These cancer drugs destroy quickly dividing cells, such as cancer cells.
You have epirubicin and oxaliplatin as a drip into your bloodstream (intravenously). And you take capecitabine as tablets.
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
central line
PICC line
portacath
You take capecitabine twice a day. You should take them within 30 minutes after eating a meal (breakfast and dinner). You swallow them whole with water.
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.
You have EOX chemotherapy as a . Each cycle lasts 3 weeks (21 days). Depending on your cancer type you have between 6 and 8 cycles.
You have each cycle of treatment in the following way:
Day 1
you have epirubicin as an injection into your vein
you have oxaliplatin as a drip over 2 hours
you take capecitabine as tablets in the morning and evening about 12 hours apart
Day 2 to Day 21
you take capecitabine as tablets in the morning and evening about 12 hours apart
You then start a new treatment cycle.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
Before starting treatment with capecitabine you have a blood test to check levels of an enzyme called dihydropyrimidine dehydrogenase (DPD). A low DPD level means you are more likely to have severe side effects from these drugs. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor, pharmacist or nurse will talk to you about this.
Find out more about having a DPD deficiency
Side effects can vary from person to person. They also depend on what other treatment you are having.
Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
you have severe side effects
your side effects aren’t getting any better
your side effects are getting worse
the side effects are affecting your daily life
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.
Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs. This is known as petechiae.
Less often bleeding can happen from other areas of the body such as your gut and back passage (rectum). Let your medical team know if you notice any blood from your rectum or in your poo.
Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.
Tell your treatment team if you have this. They can work out the cause and give you medicine to help relieve the pain.
It may be painful to swallow drinks or food. Painkillers and mouth washes can help to reduce the soreness and keep your mouth healthy.
Numbness or tingling in fingers or toes is often temporary and can usually improve slowly after you finish treatment. Talk to the team looking after you when you first notice this, especially if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons.
Oxaliplatin can make you more sensitive to the cold. It can affect your throat causing it to feel as though it is difficult to breathe and swallow. This can happen whilst you have oxaliplatin or within 2 hours of it finishing. It’s only temporary but can feel quite frightening.
Opening and closing the fridge or freezer, touching metal, eating or drinking cold foods and changes in temperature from the weather can trigger this.
It can help wearing gloves and avoid very cold food and drink for 24 hours before and after oxaliplatin.
Let your nurse know straight away if it's affecting your breathing and swallowing.
Your hair may thin or you could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will grow back once treatment has finished. But it is likely to be softer. And it may grow back a different colour or be curlier than before.
You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.
Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.
Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables.
Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.
This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.
The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.
Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.
Let your doctor or nurse know as you may be able to have creams to help manage this.
Skin and nail problems include a skin rash, dry skin, itching and darker skin. Your nails may also become brittle, dry, change colour or develop ridges. This usually goes back to normal when you finish treatment.
Your skin may appear red and flushed.
Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.
Tell your nurse straight away if you have any pain, redness, swelling or leaking around your drip site.
Also let them know if it causes pain along the vein when you have the injection.
A reaction may happen during the infusion. Symptoms can include a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction.
You might develop a cough or difficulty breathing due to an infection such as pneumonia. Or it can just be due to the drugs. Let your team know immediately if this happens.
You may gain weight while having this treatment. You may be able to control it with diet and exercise. Tell your healthcare team if you are finding it difficult to control your weight.
This can happen if you have EOX after having the main treatment for your cancer ().
It can also happen if you are having EOX because your cancer has spread but it occurs less often.
High blood sugar levels can cause headaches, feeling thirsty and blurred vision. You have regular tests to check your blood sugar levels. You may need to check your levels more often if you have .
You may have changes in levels of minerals and salts in your blood, such as low potassium and high or low sodium. Less often these drugs can make your bloods show low levels of calcium and magnesium.
You have regular blood tests during treatment to check this.
You might have some changes in the way your kidneys work. You have regular blood tests to check how well they are working.
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
constipation
a high temperature (fever) with a low level of white blood cells. This can be life threatening contact the advice line or the healthcare team if you have a high temperature
changes to how the heart works
a dry mouth
lack of fluid in the body (dehydration)
passing wind (flatulence)
depression
difficulty sleeping (insomnia)
dizziness
hiccups
pain in your gut, joints, bones, jaw, and chest
problems with moving your body causing weakness, clumsiness, loss of balance and falls
an increase in sweating
problems passing urine, blood in your urine or both
inflammation of the membranes covering the brain and spinal cord (meninges) causing symptoms similar to meningitis such as stiff neck, headaches and unable to look at bright light
inflammation of the voice box (larynx) making it difficult to speak, swallow, causing a sore throat and feeling of difficulty breathing
eye problems such as inflammation and seeing double
These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:
a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering. Contact your advice line straight away if you have any of these symptoms
a second cancer such as acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML). Talk to your doctor if this is of concern to you
the abnormal breakdown of red blood cells
feeling nervous
the imbalance of chemicals in your blood making it too acidic this can cause fast breathing, confusion, sleepiness, fatigue, or fast heart rate
blockage or slow movement of the gut
blood clotting problem causing bruising and severe bleeding
scarring and thickening of the lung tissue causing difficulty breathing
an increase in uric acid in the blood that can cause inflamed joints. You have regular blood tests to check this
hearing changes such as ringing or buzzing in the ears (tinnitus) or loss of hearing
a harmless lump caused by an overgrowth of fat cells
earache
yellowing of the skin and white of the eyes (jaundice)
soreness and redness where you had radiotherapy before
For more information about the side effects of individual drugs:
We have more information about side effects and tips on how to cope with them.
Read more about how to cope with side effects
Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.
Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.
This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment. Talk to your doctor or nurse about effective contraception before starting treatment.
Women must not become pregnant for at least 9 months after the end of treatment. Men should not father a child for at least 6 months after treatment.
Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.
You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.
If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having.
Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, and yellow fever.
You can usually have:
other vaccines, but they might not give you as much protection as usual
the flu vaccine (as an injection)
the coronavirus (COVID-19) vaccine
Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.
You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your is weakened.
Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.
Read more about immunisations and cancer treatment
For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.
You can report any side effect you have to the Medicines and Healthcare products Regulatory Agency (MHRA) as part of their Yellow Card Scheme.
Last reviewed: 11 Jul 2023
Next review due: 13 Jul 2026
Cancer drugs have side effects and these can vary from person to person. But there are things that you can do to help you cope.
Having a DPD deficiency could make the side effects of the chemotherapy drugs fluorouracil and capecitabine worse.
Chemotherapy is a standard treatment for some types of cancer. It uses anti cancer drugs to destroy cancer cells.
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