epirubicin

Epirubicin is a chemotherapy agent in the anthracycline class. It is a semisynthetic derivative of doxorubicin (the 4'-epimer) and is marketed under names such as Ellence. Like other anthracyclines, it is used to treat various solid tumors and is commonly included in combination regimens.

The drug works by intercalating into DNA and inhibiting the enzyme topoisomerase II, which leads to DNA damage and cell death. It also generates free radicals that contribute to cytotoxic effects. Epirubicin is rapidly distributed after intravenous administration and undergoes hepatic metabolism. It is primarily eliminated in the urine and bile, and its clearance can be affected by liver function. Dosing is usually based on body surface area and is given in cycles, often every two to three weeks, depending on the regimen.

Epirubicin is used for several cancers, most notably breast cancer, and is also employed in regimens for gastric, ovarian, and other cancers. It is commonly given in combination with other agents such as cyclophosphamide, fluorouracil, cisplatin, or taxanes. The exact regimen depends on cancer type, stage, and prior treatment.

Adverse effects are typical of the anthracycline class and include myelosuppression, nausea, vomiting, mucositis, diarrhea, alopecia, and fatigue. A dose-related risk of cardiotoxicity exists, potentially leading to congestive heart failure, and is related to cumulative exposure. Other risks include hepatotoxicity and a tendency to cause reddish discoloration of urine and sweat. Careful monitoring of heart function and liver function is advised, and treatment decisions consider cumulative dose and chest radiotherapy exposure.