Epirubicin — Drug Monograph

Brand names: Ellence

Drug class: Anthracycline

Mechanism of Action

Epimer of doxorubicin at the 4'-hydroxyl group of the sugar moiety. Mechanism of action identical to doxorubicin (topoisomerase II inhibition, DNA intercalation, free radical generation). The epimeric configuration reduces cardiotoxicity compared to doxorubicin at equivalent molar doses.

FDA Indications

• Adjuvant treatment of axillary lymph node positive breast cancer (as part of the FEC-100 or EC regimen)

Common Side Effects

• Myelosuppression
• Alopecia
• Nausea and vomiting
• Mucositis
• Amenorrhea
• Red discoloration of urine (2 days)

Clinical Pearl

Epirubicin is dose-equivalent to doxorubicin at a ratio of approximately 1.2–1.5:1 (more epirubicin needed for same antitumor effect) but with a higher cumulative cardiotoxicity threshold. In the FEC-100 regimen (fluorouracil 500, epirubicin 100, cyclophosphamide 500 mg/m²), 6 cycles represents a cumulative epirubicin dose of 600 mg/m² — well within safe limits.

Related Therapies & Mechanisms

• Doxorubicin (Adriamycin) — Anthracycline · Breast
• Paclitaxel (Taxol) — Breast
• Pembrolizumab (Keytruda) — Breast
• Liposomal Doxorubicin (Pegylated) (Doxil) — Anthracycline · Breast