EC chemotherapy

EC is a combination of 2 chemotherapy drugs used to treat breast cancer.

It takes its name from the initials of these drugs:

• Epirubicin
• Cyclophosphamide

Primary breast cancer

EC chemotherapy can be used to treat primary breast cancer. 

Before surgery

You may have EC chemotherapy before surgery to shrink a larger breast cancer. This may mean breast-conserving surgery (a lumpectomy or wide local excision) is an option, rather than a mastectomy.

Or you might have it before surgery to slow down the growth of a fast-growing breast cancer and reduce the chance of it spreading to other parts of the body.

You may be more likely to have chemotherapy before surgery if you have a certain type of breast cancer, such as inflammatory breast cancer, HER2-positive breast cancer or triple negative breast cancer.

When you have EC chemotherapy before surgery, it’s called primary or neo-adjuvant chemotherapy.

After surgery

You may have EC chemotherapy after surgery to reduce the risk of breast cancer coming back in the future. It usually starts a few weeks after your operation.

If you’re going to have radiotherapy, you will usually finish your course of EC chemotherapy first.

When chemotherapy is given after surgery, it’s called adjuvant therapy.

If your breast cancer has come back (recurrence) or spread (secondary breast cancer)

You may have EC chemotherapy if your breast cancer has:

• Come back in the chest/breast area or in the skin near the original site or scar (local recurrence)
• Come back and spread to the tissues and lymph nodes around the chest, neck and under the breastbone (locally advanced breast cancer)
• Spread to other parts of the body (secondary breast cancer)

Before starting your treatment, your treatment team will discuss how and when you’ll have EC chemotherapy and how side effects can be managed.

You’ll have blood tests and your height and weight will be measured.

You may also have tests to check your heart function, such as:

• An ECG (electrocardiogram)
• An ECHO (echocardiogram)
• A MUGA (multiple-gated acquisition) scan

You should be given a 24-hour contact number or told who to contact if you feel unwell at any time during your treatment, including at night or at the weekends.

EC chemotherapy is given into a vein (intravenously). 

This will usually be through a cannula into a vein in the back of your hand or lower arm.

You could also have EC chemotherapy through:

• A skin-tunnelled catheter (Hickman line): a tube inserted into a vein in your chest
• A peripherally inserted central catheter (PICC): a tube inserted into a vein in your arm at or above the bend in your elbow
• An implanted port: a device with a tube that goes into a vein that’s put under the skin, usually in your chest or arm

You will have EC chemotherapy as an outpatient.

How long will I have EC chemotherapy?

You usually have 1 dose of EC chemotherapy every 2 or 3 weeks. This is known as a cycle. You’ll be given both drugs on the same day.

You’ll normally have 3 to 6 cycles of EC chemotherapy, over 3 to 4 months. This may change depending on how well your body tolerates the drugs.

If you’re given EC chemotherapy for 3 to 4 cycles, you may have it before or after another chemotherapy drug such as docetaxel or paclitaxel.

The gap between each cycle of treatment gives your body time to recover. Chemotherapy can reduce the amount of blood cells in your body. You might have a longer gap between cycles if your blood tests show that the number of blood cells hasn’t returned to normal.

Like any treatment, EC chemotherapy can cause side effects. Everyone reacts differently to drugs and some people have more side effects than others. These side effects can usually be managed and those described here will not affect everyone.

If you’re worried about any side effects, regardless of whether they’re listed here, talk to your chemotherapy nurse or treatment team.

Common side effects

Effects on the blood

EC chemotherapy can temporarily affect the number of blood cells in the body. Blood is made up of red cells, white cells and platelets.

You’ll have regular blood tests. If these show the number of blood cells is too low, your next course of treatment may be delayed or the dose of chemotherapy reduced.

Risk of infection

Not having enough white blood cells can increase the risk of getting an infection.

Before starting chemotherapy, you should be given a 24-hour contact number or told who to contact if you feel unwell at any time during your treatment, including overnight or at the weekends.

You may need treatment if you get an infection.

Sometimes your doctor may recommend injections of drugs called growth factors. This helps the body produce more white blood cells to reduce your risk of infection.

Anaemia

Having too few red blood cells is called anaemia. If you feel breathless, dizzy or particularly tired, let your treatment team know.

Bruising and bleeding

EC chemotherapy can reduce the number of platelets, which help the blood to clot.

You may bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth.

Tell your treatment team if you have any of these symptoms.

Hair loss

EC chemotherapy causes hair loss. Most people will lose all their hair, including hair on their head, eyebrows, eyelashes and body hair.

You may begin to lose your hair around 2 weeks after your first treatment, but this can happen sooner.

Scalp cooling may stop you losing some, or all, of the hair on your head. Ask your treatment team if scalp cooling is available in your hospital.

Any hair loss should be temporary. For most people, hair will begin to grow back in the weeks and months after EC chemotherapy has finished.

Find out more about coping with hair loss.

Nausea and vomiting

You may feel sick (nausea) or be sick (vomit).

You may start to feel unwell a few hours after your treatment. You’ll be given anti-sickness medication, as tablets or into a vein, before each cycle of chemotherapy.

You’ll also have some anti-sickness tablets to take home.

If nausea and vomiting are affecting you, let your treatment team know.

Contact your treatment team or the 24-hour helpline number if you have severe vomiting and cannot drink any fluids without vomiting, even if it happens at the weekend or during the night.

Reaction at the injection site

You might get pain, redness, discolouration or swelling where the cannula (small plastic tube) has been inserted or anywhere along the vein, during or after treatment.

If epirubicin leaks out of the vein it is being given in (called extravasation), it can damage the surrounding tissue.

Tell your treatment team immediately if you have pain, stinging or a burning sensation around the cannula while the drug is being given.

After a few weeks you may notice tenderness, darkening and hardening around where the cannula was inserted. This should fade in time.

Feeling flushed

While cyclophosphamide is being given, you may feel hot, flushed or dizzy.

Tell your chemotherapy nurse if you experience any of the above symptoms. These usually go away when cyclophosphamide has been given.

Bladder irritation and pink or red urine

Cyclophosphamide can irritate the lining of the bladder (cystitis).

It’s important to drink plenty of fluids around the time you have your treatment.

Try to pee regularly, or as soon as you feel the urge. Tell your treatment team if you notice:

• Blood in your urine
• Irritation or a burning/stinging sensation when you pee

Epirubicin can cause your urine to become pink or red for a couple of days. This is because of the colour of the drug and is completely normal.

Sore mouth

Looking after your mouth, including your teeth and gums, is very important during treatment.

You may be given mouthwash to try to reduce soreness and stop mouth ulcers developing. It’s a good idea to use a small, soft toothbrush during this time.

See your dentist for a check-up before treatment with chemotherapy begins. Avoid dental work during treatment if possible.

If you do need to have dental work during chemotherapy, talk with your treatment team about the best time to have this.

If you’re having difficulty registering with a dentist, let your treatment team know.

Taste changes

EC chemotherapy can change your sense of taste. Some foods may taste different, for example more salty, bitter or metallic.

You may no longer enjoy some of the foods you used to. If this is the case, speak to your treatment team. They may suggest ways to manage this.  

Your taste should return to normal once your treatment has finished.

Our information on diet during breast cancer treatment includes tips for dealing with taste changes.

Sore eyes

Your eyes may feel sore, gritty or watery. Speak to your treatment team if you experience any of these symptoms. They may prescribe eye drops.

Blocked or runny nose

EC chemotherapy can cause a blocked or runny nose. Tell your treatment team if this happens while your chemotherapy is being given.

Extreme tiredness (cancer-related fatigue)

Fatigue is extreme tiredness that does not go away with rest or sleep. It’s a very common side effect of EC chemotherapy and may last for weeks or months after your treatment has finished.

If you think you have fatigue, tell your treatment team or GP. They can assess you and offer advice on how to manage your energy levels.

Find out more about managing fatigue.

Menopausal symptoms

EC chemotherapy may cause menopausal symptoms if you haven’t already been through the menopause. This is because it affects the ovaries, which produce the hormone oestrogen.

Your periods may stop or become irregular during EC chemotherapy. Whether your periods return depends on:

• Your treatment and its dose
• Your age

Common menopausal symptoms include:

• Hot flushes and night sweats
• Mood changes
• Joint aches and pains
• Vaginal dryness
• Changes to your sex drive

Tell your treatment team if you experience any menopausal symptoms. They may suggest ways of managing these.

Find out more about breast cancer and menopausal symptoms.

Effects on your concentration

Treatment can affect your ability to concentrate and may make you more forgetful.

This is sometimes referred to as “chemo-brain” or “chemo-fog”, but your treatment team may call it cognitive impairment. It usually improves over time after treatment has finished.

Less common side effects of EC chemotherapy

Heart changes

Epirubicin can affect the way your heart works and may not be suitable if you have an existing heart condition.

Your treatment team may arrange a heart (cardiac) function test, such as an echocardiogram, to check how your heart is working before you start chemotherapy.

Skin reactions

Epirubicin may cause your skin to become darker, red and sore. You may develop a rash, especially if you’ve had radiotherapy recently.

These symptoms may appear differently on various skin tones.

Your skin may also darken due to extra colour (pigment) being produced. Any darkening usually returns to normal a few months after the treatment ends.

Let your treatment team know if you notice any skin reactions.

During EC chemotherapy treatment, and for several months afterwards, your skin will be more sensitive. You’ll be more likely to get sunburnt, so wear sunscreen with a high sun protection factor (SPF) if you’re out in the sun.

Blood clots

People with breast cancer have a higher risk of blood clots. Having EC chemotherapy also increases the risk of blood clots such as a DVT (deep vein thrombosis).

If you have a DVT, there’s a risk part of the blood clot could break away and travel to the lung. This is known as a pulmonary embolism (PE).

Blood clots can be life-threatening and should be treated quickly.

Sex, contraception and pregnancy

You can still have sex during treatment. It’s thought that chemotherapy drugs cannot pass into vaginal fluids or semen, but this cannot be completely ruled out.

Most treatment teams will advise using barrier methods of contraception, such as condoms or female condoms, during treatment and for a few days after chemotherapy is given. Men having EC should use contraception during treatment and for 6 months afterwards.

You’re advised not to become pregnant while having treatment because EC chemotherapy can harm a developing baby. If you have not been through the menopause, talk to your treatment team about the most suitable method of contraception for you and how long to use it for after the last dose of EC chemotherapy. It’s still possible to become pregnant even if your periods become irregular or have stopped.

Find out more about how breast cancer and its treatment can affect sex and intimacy and read more information on how to manage these changes.

Fertility

EC chemotherapy can affect your fertility (ability to become pregnant) and may make you unable to get pregnant. This can be temporary or permanent. The risk of it being permanent increases with age.  

Some studies show that ovarian suppression using hormone therapy drugs may protect the ovaries during chemotherapy. This is because it temporarily “shuts down” the ovaries. However, the effectiveness of ovarian suppression for preserving fertility is still debated.

It’s important to discuss any fertility concerns with your treatment team before you start treatment. They may be able to refer you to a fertility specialist to discuss fertility preservation options.

Find out more about how breast cancer treatment can affect fertility.

Breastfeeding

You’ll be advised not to breastfeed during treatment with EC chemotherapy. This is because there is a chance your baby may absorb the drug through your breast milk, which can cause harm.

Vaccinations and travel

If you’re planning a holiday or need to travel overseas, check with your treatment team first.

You should not have any live vaccines while you’re having treatment.

For more information about vaccines, including COVID-19 and flu vaccines, see our information on vaccines and breast cancer. 

Your treatment team and breast care nurse can help with any questions you have. You can also speak to our specialist nurses on our free helpline (see below).

You can find people going through treatment at the same time as you on the monthly chemotherapy threads on our online forum.

You can also speak to someone who has had chemotherapy for primary breast cancer through our Someone Like Me service – see below.

If you have secondary breast cancer, our Living with Secondary Breast Cancer services can help you meet others in a similar situation, and offers helpful support and information in a relaxed environment – see below.