Having received a couple of messages requesting more information regarding the EOX cocktail combo.
I am going to cascade on the Blog for general consumption as follows>>….
EOX is the name of a chemotherapy combination. It includes the drugs:
- E – epirubicin
- O – oxaliplatin
- C – capecitabine (Xeloda)
How EOX works
These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.
How you have EOX
- capecitabine as a tablet – you take it twice a day, morning and night, swallow it whole with plenty of water
- epirubicin as an injection into your bloodstream (intravenously) once each cycle
- oxaliplatin as a drip into your bloodstream once each cycle
Into your bloodstream
You have oxaliplatin and epirubicin into your bloodstream. You can have these drugs through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment or alternatively through a port / central line
Tests during treatment
You have blood tests before starting treatment 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.
Risk of infection
EOX can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
- your temperature goes over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
EOX can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
EOX can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
This can sometimes be severe. Your doctor can prescribe anti-diarrhoea drugs to control it. You may be given these before you leave hospital. It’s important to take them exactly as your nurse or pharmacist explains. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
If you have diarrhoea more than 4–6 times a day, or at night, contact the hospital straight away on the numbers your nurse gave you. Your doctor may ask you to stop taking capecitabine. When the diarrhoea is better, they will tell you if you can start taking it again. Sometimes they reduce the dose.
Oxaliplatin may make you constipated and cause tummy pain. Drinking at least two litres (three and a half pints) of fluids every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and do some regular, gentle exercise.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
EOX may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. During treatment and for several months afterwards, you’ll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat.
Your skin may darken. It will return to its normal colour after you finish treatment. If you’ve had radiotherapy, either recently or in the past, the area that was treated may become red or sore.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Numb or tingling hands or feet
These symptoms are caused by the effect of oxaliplatin on the nerves. It’s called peripheral neuropathy. You may find it hard to fasten buttons or do other fiddly tasks. The symptoms usually improve slowly after treatment finishes, but in some people they may never go away.
Your nails may become brittle and break easily. They may get darker or discoloured, and/or you may get lines or ridges on them. These changes grow out after treatment finishes. Wearing gloves when washing dishes or using detergents will help protect your nails during treatment.
Your urine may become a pink-red colour for up to 48 hours after you’ve had the treatment. This is normal and due to the colour of epirubicin.
Your eyes may become watery and feel sore and may become more sensitive to light. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops.
EOX may also cause blurry vision and/or eye pain.
Breathing and swallowing
Oxaliplatin can affect the area around the voicebox (larynx). This can make it feel difficult to swallow or to breathe. This can feel very frightening, but only lasts a short while. Try taking long deep breaths through your nose to help your breathing get back to normal. The symptoms can be made worse by cold temperatures. Avoid having cold drinks or ice cubes for a few days after treatment.
Some people may have pain or ringing in their ears (tinnitus). Rarely, oxaliplatin may cause some hearing loss.
Changes in the way the heart works
Epirubicin can affect the way the heart works. You may have tests to see how well your heart is working before, during and sometimes after treatment.
If you have pain or tightness in your chest, feel breathless, or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away.
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain.
EOX may interact with different drugs. It may also affect the way blood-thinning drugs, such as warfarin, work. The vitamin folic acid can increase the side effects of capecitabine.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in your semen or vaginal fluid.
Changes to your periods
EOX can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women this is temporary, but for others it is permanent and they start the menopause.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Explain you are taking chemotherapy tablets that no one should stop or restart without advice from your cancer doctor. Give them the contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.