Side Effects of epirubicin: A Synthesis of Findings from 28 Studies

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Original Abstract of the Article

Major Research Findings

Epirubicin is a chemotherapy drug often used to treat breast cancer. Several studies have shown its effectiveness, but they have also reported some side effects. In a study by 19 , epirubicin was found to cause side effects such as nausea, vomiting, and febrile neutropenia. 20 also reports that epirubicin can cause severe damage to normal bladder epithelium when used to treat bladder cancer, leading to intolerable side effects. Additionally, 2 suggests that epirubicin may negatively affect vascular function. Epirubicin may hinder the S-nitrosylation of proteins within vascular endothelial cells, potentially inhibiting vasodilation, vasoconstriction, and angiogenesis.

Reasons for Side Effects

The side effects of epirubicin are mainly attributed to its ability to hinder the synthesis of cell DNA. Epirubicin binds to DNA, altering its structure and inhibiting the growth and division of cells. However, this action can also impact normal cells, leading to potential side effects.

Common Side Effects

Nausea and Vomiting

Epirubicin can trigger gastrointestinal side effects, such as nausea and vomiting. In the study by 13 , a higher incidence of nausea and vomiting was observed in patients undergoing chemotherapy with epirubicin in combination with other anti-cancer drugs. It's believed that these side effects are caused by the stimulation of gastrointestinal nerve cells by anti-cancer drugs.

Febrile Neutropenia

Epirubicin can suppress bone marrow function, potentially leading to a decrease in white blood cell count and resulting in febrile neutropenia. The study by 7 reported a higher incidence of febrile neutropenia in patients receiving chemotherapy with epirubicin. This side effect is thought to be caused by the destruction of hematopoietic cells in the bone marrow by anti-cancer drugs.

Cardiotoxicity

Epirubicin can cause cardiotoxicity, a side effect that negatively affects the heart. The study by 5 demonstrates that epirubicin inhibits the function of myocardial cells. This side effect is believed to be caused by the accumulation of anti-cancer drugs in heart muscle cells.

Cystitis

Epirubicin can cause cystitis, an inflammation of the bladder. In the study by 18 , a higher incidence of cystitis was reported in patients receiving intravesical epirubicin. It is believed that this side effect is caused by the stimulation of the bladder mucosa by the anti-cancer drug.

Skin Reactions

Epirubicin can lead to skin reactions. The study by 18 reported a higher incidence of skin reactions in patients receiving intravesical epirubicin. It is thought that this side effect is caused by the direct contact of the anti-cancer drug with the skin.

Adverse Effects on Vascular Function

Epirubicin may inhibit vascular function. The study by 2 shows that epirubicin may hinder the S-nitrosylation of proteins within vascular endothelial cells, potentially inhibiting vasodilation, vasoconstriction, and angiogenesis. This side effect is believed to be caused by the accumulation of anti-cancer drugs in vascular endothelial cells.

Countermeasures for Side Effects

Countermeasures for Nausea and Vomiting

Anti-emetics can be used to combat nausea and vomiting. Antiemetics are medications that can be taken before receiving anti-cancer drugs to prevent nausea and vomiting. The study by 13 demonstrates the effectiveness of antiemetics in patients receiving chemotherapy with epirubicin in combination with other anti-cancer drugs.

Countermeasures for Febrile Neutropenia

Administration of granulocyte colony-stimulating factor (G-CSF) can help manage febrile neutropenia. G-CSF stimulates hematopoietic cells in the bone marrow to increase the number of white blood cells. The study by 7 shows the effectiveness of G-CSF in patients receiving chemotherapy with epirubicin.

Countermeasures for Cardiotoxicity

Dexrazoxane can be used to address cardiotoxicity. Dexrazoxane reduces the damage epirubicin causes to the heart. The study by 5 demonstrates that dexrazoxane reduces cardiotoxicity caused by epirubicin.

Countermeasures for Cystitis

Antibiotics or washing out the bladder can be used to manage cystitis. Antibiotics kill bacteria that cause cystitis. The study by 18 shows the effectiveness of antibiotics in patients receiving intravesical epirubicin.

Comparison of Studies

Common Points of Studies

Multiple studies have shown that epirubicin is an effective anti-cancer drug, while it can cause serious side effects such as nausea, vomiting, and febrile neutropenia.

Differences in Studies

Since the methods of administering epirubicin and the drugs used in combination vary between studies, the incidence and types of side effects may differ. For example, 19 compares epirubicin with pegylated liposomal doxorubicin and examines the effectiveness and side effects of both drugs in detail. On the other hand, 20 focuses on the side effects of epirubicin when used to treat bladder cancer.

Points to Note for Application to Real Life

Epirubicin is a powerful anti-cancer drug, and it is important to understand the risks of side effects before undergoing treatment. If you are concerned about side effects, consult your doctor.

Limitations of Current Research

Current research cannot fully predict the side effects of epirubicin. Also, treatment methods to reduce side effects are not yet fully established. Further research is needed to gain a deeper understanding of the side effects of epirubicin and to develop new treatment methods to reduce them.

Future Research Directions Needed

The following research is considered necessary to gain a deeper understanding of the side effects of epirubicin.

  • Research to clarify the mechanisms of epirubicin side effects
  • Exploration of new biomarkers to predict epirubicin side effects
  • Development of new treatments to reduce epirubicin side effects

Conclusion

Epirubicin is an effective anti-cancer drug, but it is important to understand the risks of side effects before undergoing treatment. If you are concerned about side effects, consult your doctor. Future research is expected to lead to a deeper understanding of the side effects of epirubicin and the development of new treatment methods to reduce them.

Literature analysis of 28 papers
Positive Content
26
Neutral Content
0
Negative Content
2
Article Type
3
0
1
3
27
3.

Epirubicin: Biological Properties, Analytical Methods, and Drug Delivery Nanosystems.

Author: LuizMarcela Tavares, DutraJessyca Aparecida Paes, Di FilippoLeonardo Delello, JuniorAlberto Gomes Tavares, TofaniLarissa Bueno, MarchettiJuliana Maldonado, ChorilliMarlus

EPI delivery in nanosystems
Improved safety and efficacy
Cardiotoxicity
Myelosuppression

Epirubicin (EPI), an anthracycline drug, is commonly used for treating various tumors. Its delivery in nanosystems can enhance its safety and efficacy, offering advantages in overcoming cardiotoxicity and myelosuppression.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

6.

Systemic Lupus Erythematosus is Not Necessarily a Contraindication to Adjuvant Breast Radiation Therapy.

Author: MartellKevin, LongKaren, SolisAlexa, OlivottoIvo A

Treats breast cancer
Acute dermatitis
Radiation-induced side effects

This case report describes a 41-year-old woman with systemic lupus erythematosus (SLE) who received adjuvant radiotherapy for inflammatory breast cancer. Despite SLE, the patient tolerated radiotherapy well with minimal side effects.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

7.

Chemotherapy-induced febrile neutropenia: primary G-CSF prophylaxis indicated during docetaxel cycles.

Author: van DooijeweertC, van der WallE, BaasI O

Prevents FN
Expensive
Side effects

Chemotherapy can cause a dangerous condition called febrile neutropenia, which is a low white blood cell count that can lead to infections. This study evaluated whether giving granulocyte colony-stimulating factor (G-CSF) during chemotherapy cycles when the risk of neutropenia is high is more effective than giving it during other cycles.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

8.

Hepatic Arterial Infusion Chemotherapy Using Oxaliplatin Plus 5-Fluorouracil Versus Transarterial Chemoembolization/Embolization for the Treatment of Advanced Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombosis.

Author: HuJungang, BaoQuan, CaoGuang, ZhuXu, YangRenjie, JiXinqiang, XuLiang, ZhengKanglian, LiWeiliang, XingBaocai, WangXiaodong

HCC treatment
Tumor control
Hematologic abnormalities
Liver dysfunction

Hepatic arterial infusion chemotherapy (HAIC) significantly improved overall survival (OS) and provided better tumor control with mild side effects compared to transarterial chemoembolization/embolization (TACE/TAE) in patients with advanced hepatocellular carcinoma (HCC) with major portal vein tumor thrombosis (PVTT).

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

9.

Accelerated versus standard epirubicin followed by cyclophosphamide, methotrexate, and fluorouracil or capecitabine as adjuvant therapy for breast cancer (UK TACT2; CRUK/05/19): quality of life results from a multicentre, phase 3, open-label, randomised, controlled trial.

Author: VelikovaGalina, MordenJames P, HavilandJoanne S, EmeryCharlotte, Barrett-LeePeter, EarlHelena, BloomfieldDavid, BruntAdrian Murray, CanneyPeter, ColemanRobert, VerrillMark, WardleyAndrew, BertelliGianfilippo, EllisPaul, SteinRob, BlissJudith M, CameronDavid,

Breast cancer treatment
Chemotherapy toxicity

The TACT2 trial investigated the effectiveness and side effects of two chemotherapy regimens for early breast cancer. Accelerated epirubicin showed no benefit, while capecitabine was found to be non-inferior to CMF in terms of efficacy but with fewer side effects.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

15.

Effects of Inositol Hexaphosphate and Myo-Inositol Administration in Breast Cancer Patients during Adjuvant Chemotherapy.

Author: AmabileMaria Ida, De LucaAlessandro, TripodiDomenico, D'AlbertiElena, MelcarneRossella, ImbimboGiovanni, PicconiOrietta, D'AndreaVito, VergineMassimo, SorrentiSalvatore, MolfinoAlessio

Improved functional status
Improved local side effects
Improved quality-of-life

This study investigated the potential beneficial effects of a combined therapy with oral myo-inositol administration and topical IP6 application in patients undergoing surgery for breast cancer (BC) and eligible to adjuvant chemotherapy.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

16.

Hypnosis Sedation Reduces the Duration of Different Side Effects of Cancer Treatments in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy.

Author: BerliereMartine, PietteNathan, BernardMarion, LacroixCamille, GerdayAmandine, SamartziVasiliki, CoyetteMaude, RoelantsFabienne, DocquierMarie-Agnes, TouilNassim, WatremezChristine, PiettePhilippe, DuhouxFran Ois P

Side effect reduction

This prospective non-randomized study evaluated the effects of hypnosis sedation in 63 breast cancer patients receiving neoadjuvant chemotherapy. The study found that hypnosis sedation may reduce the duration of polyneuropathy, musculoskeletal pain, postoperative pain, and cancer-related fatigue. However, the study was limited by its small size and lack of randomization.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

18.

Single postoperative instillation for non-muscle invasive bladder cancer: are there still any indication?

Author: ZamboniStefania, BaumeisterPhilipp, MatteiAgostino, MordasiniLivio, AntonelliAlessandro, SimeoneClaudio, MoschiniMarco

NMIBC recurrence
Chemical cystitis
Skin reaction

Early single chemotherapeutical instillation (SI) after transurethral resection is effective in reducing recurrence in low-intermediate risk non-muscle invasive bladder cancer (NMIBC) patients. Epirubicin or mitomycin C are particularly effective for SI. While SI is generally safe, rare severe complications, mostly due to extravasation of drugs, can occur.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

21.

Neoadjuvant Pyrotinib plus Trastuzumab and Chemotherapy for Stage I-III HER2-Positive Breast Cancer: A Phase II Clinical Trial.

Author: XuhongJuncheng, QiXiaowei, TangPeng, FanLinjun, ChenLi, ZhangFan, TanXuanni, YanWenting, ZhongLing, HeCheng, LiangYan, RenLin, WangMinghao, ZhangYi, JiangJun

Effective therapy
Safe therapy

Pyrotinib, a new drug, has shown promise as a neoadjuvant therapy for HER2-positive breast cancer. This study found that pyrotinib combined with other chemotherapy drugs was effective and safe in treating HER2-positive breast cancer. Further research is needed to confirm these findings.

Clinical Trial, Phase IIA Phase II trial is a trial that further evaluates the efficacy and safety of a new drug or treatment, whose safety has been confirmed to some extent in a Phase I trial, in a small number of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

23.

The Efficacy and Safety of Modified Docetaxel, Cisplatin, and 5-Fluorouracil Vs. Epirubicin, Oxaliplatin, and Capecitabine Regimen in the Advanced Gastric Cancer: A Randomized Controlled Clinical Trial.

Author: AhmadzadehAhmad, SeyedianSeyed Saeid, ValizadehArmita, SoleimaniMahin, NazariPedram, HamidiHossein

Gastric cancer treatment

This study explores the use of modified docetaxel, cisplatin, and 5-fluorouracil (m-DCF) and epirubicin, oxaliplatin, and capecitabine (EOX) regimens for the treatment of advanced gastric cancer. Clinical trials have shown that these regimens may be superior to other treatment options.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

24.

Development of Epirubicin-Loaded Biocompatible Polymer PLA-PEG-PLA Nanoparticles: Synthesis, Characterization, Stability, and In Vitro Anticancerous Assessment.

Author: MassadehSalam, AlmohammedIman, BarhoushEman, OmerMustafa, AldhawiNouf, AlmalikAbdulaziz, AlaameryManal

Cancer treatment
Cardiotoxicity

Epirubicin (EPI) is a chemotherapy drug with less cardiotoxicity than doxorubicin. This study aims to develop EPI nanoparticles as an improved formulation of conventional EPI treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

25.

Dose tailoring of adjuvant chemotherapy for breast cancer based on hematologic toxicities: further results from the prospective PANTHER study with focus on obese patients.

Author: MatikasA, FoukakisT, MoebusV, GreilR, BengtssonN-O, StegerG G, UntchM, JohanssonH, HellströmM, MalmströmP, GnantM, LoiblS, BerghJ

Improved BCRFS
Improved overall survival
Toxicity

Adjuvant chemotherapy (ACT) can improve outcomes for breast cancer patients. This study evaluated the efficacy of tailored dosing of ACT in a clinical trial.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

27.

Polymeric micelles effectively reprogram the tumor microenvironment to potentiate nano-immunotherapy in mouse breast cancer models.

Author: PanagiMyrofora, MpekrisFotios, ChenPengwen, VoutouriChrysovalantis, NakagawaYasuhiro, MartinJohn D, HiroiTetsuro, HashimotoHiroko, DemetriouPhilippos, PieridesChryso, SamuelRekha, StylianouAndreas, MichaelChristina, FukushimaShigeto, GeorgiouParaskevi, PapageorgisPanagiotis, PapaphilippouPetri Ch, KoumasLaura, CosteasPaul, IshiiGenichiro, KojimaMotohiro, KataokaKazunori, CabralHoracio, StylianopoulosTriantafyllos

Immunological memory
Improved outcomes

This research investigated the use of tranilast-loaded micelles for reprogramming cancer-associated fibroblasts (CAFs) in breast cancer. Tranilast-micelles were found to significantly enhance CAF reprogramming compared to free tranilast, leading to improved therapeutic delivery and immunostimulation. Combined therapy with tranilast-micelles, epirubicin-micelles or Doxil, and immunotherapy resulted in cures and immunological memory in mice with immunotherapy-resistant breast cancer. Additionally, shear wave elastography (SWE) was identified as a potential biomarker for monitoring tumor stiffness and predicting response to nano-immunotherapy.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

28.

Taste and Smell Disorders in Cancer Treatment: Results from an Integrative Rapid Systematic Review.

Author: Buttiron WebberTania, BriataIrene Maria, DeCensiAndrea, CevascoIsabella, PaleariLaura

TSD treatment

Changes in taste and smell are common side effects of cancer treatments, impacting a patient's quality of life. This review identified several cancer drugs that frequently cause these problems, including docetaxel, paclitaxel, capecitabine, cyclophosphamide, and others. The study found that taste problems occurred in 17-86% of patients, while smell problems affected 8-45%. Further research is needed to better understand and prevent these side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

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