EOX Chemotherapy

A EOX chemotherapy regimen is often used in the treatment of stomach cancer. It is a combination of Epirubicin, Oxaliplatin and Capecitabine.

Its main use is in advanced malignancy or as pre-operative therapy to shrink your tumor and make it more amenable to surgery.

On current evidence, the effectiveness is probably better than the alternative FOLFOX (a 2 chemo agent regimen), but is less well tolerated.

It is also of benefit as a neoadjuvant treatment in those with operable cancers.

What Is EOX Chemotherapy?

EOX is an abbreviation for:

Epirubicin (trade name Ellence - a red liquid) = E

Oxplatin (trade name Eloxatin - a colourless liquid) = O

Capecitabine tablets (trade name Xeloda) = X

Epirubicin and Oxplatin are given intravenously either through your central line (HICKMAN line) and normally takes about 2-3 hours to give.

The Capecitabine is a tablet and is taken twice a day with water and food. It is known as a prodrug as the body converts it in the active form, known as 5-Flurouracil.

The tablets are normally taken for 14 days and the therapy normally lasts 3 weeks or 21 days before you have a further cycle of treatment.

In total, you can have up to 8 cycles or 24 weeks of this form of chemo. The length is really dictated by the response of your tumor to it.

Are There Any Side Effects?

Like any form of chemotherapy, EOX Chemotherapy does have side effects. These include:

Phlebitis – inflamed vein when having intravenous treatment

Allergic Reaction To Drugs – Unusual

Hot Flushes – Common

Nausea and Vomiting

Risk of Pancytopenia – this is when the blood cells are low and normally occurs about a week after chemotherapy. This increases risk of:

  • Bleeding – due to low levels of your platelet cells
  • Serious infections – due to low white cell numbers or "neutropenia”
  • Anemia – Due to a drop in your haemoglobin levels which can make you feel breathless, tired, give you headaches and fatigue

Mucositis -  a medical term for a sore mouth and can cause swallowing problems. This is often worse with cold drinks

Diarrhea and Constipation – either can occur with EOX chemotherapy

Altered Taste – you may go off certain drinks and foods that you once enjoyed.

Hair loss – can cause complete hair loss

Fertility Problems


Sore Eyes and Conjunctivitis

Peripheral Neuropathy – Painful or numb hands and feet

Skin Problems – Rashes and scaly hands and feet

Red Urine – due to the Epirubicin and normally occurs in the first 24-48 hours of treatment

Heart Problems – rarely, Epirubicin can cause myocarditis and heart failure. If you start feeling breathless, seek immediate medical advice

When Having This Form Of Chemotherapy

  • Try To Keep Your Fluid Levels Up
  • Try To Maintain Your Nutrition or Food Intake – have fortified drinks if unable to eat
  • Keep Away From Anyone With Infections – particularly viral infections such as chicken pox and shingles
  • Avoid LIVE Vaccines – discuss with your doctor if you need any vaccines
  • Maintain Good Oral Hygiene – it is important to brush your teeth regularly and use mouthwashes if you develop any soreness in your mouth

How Effective Is The Treatment?

There have been land mark trials showing the benefits of EOX chemotherapy. Studies such as MAGIC and the FNCLCC/FFCD trials have proven efficacy of perioperative chemotherapy rather than surgery alone with approximately a 10% increased survival rate.

EOX chemotherapy is very effective. Studies have shown that between 10 and 39% will have a good response (1, 2) and 11.5% will get complete regression with this form of treatment prior to surgery.

The mean 1 year survival rate with this form of therapy is 46.8% (3).

Further Information:

1)      FOLFOX Versus EOX Chemotherapy As A Neoadjuvant Chemotherapy Regimen For Patients With Advanced Gastric Cancer

Chen, W et al. Exp Ther Med. 2014 Feb; 7(2): 461-467.

2)      Comparison Between DCF (Docetaxel, Cisplatin And 5-Flurouracil) And Modified EOX (Epirubicin, Oxaliplatin And Capecitabine) As Palliative First-Line Chemotherapy For Adenocarcinoma Of The Upper Gastrointestinal Tract

Iihan-Mutlu, A et al. Anticancer Res. 2013 Aug;33(8):3455-9.

3)      Capecitabine And Oxaliplatin For Advanced Esophagogastric Cancer

Cunningham, D et al. N Engl J Med 2008;358:36-46.

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