Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.
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regimen-monograph
EC
A - Regimen Name
EC Regimen
EPIrubicin-Cyclophosphamide
Disease Site
Breast
Intent
Palliative
Regimen Category
Local : A regimen not widely used by Regional Cancer Centres in this disease site.
Rationale and Uses
Treatment of advanced breast cancer
B - Drug Regimen
| cyclophosphamide
(Round to nearest 10 mg) |
600 mg /m² | IV | Day 1 |
| EPIrubicin
(Round to nearest 1 mg) |
60 mg /m² | IV | Day 1 |
C - Cycle Frequency
REPEAT EVERY 21 DAYS Until evidence of non-response, disease progression or limited by cardiotoxicity risk
E - Dose Modifications
Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.
Dosage with toxicity
Hematologic Toxicities: See Appendix 6 for general recommendations.
Hepatic Impairment
| Bilirubin | Dose |
| 1 - 1.5 x ULN | Reduce Epirubicin to 50-100% of dose |
| 1.5 - 2 x ULN | Reduce Epirubicin to 50% of dose |
| 2 - 4 x ULN | Reduce Epirubicin to 25-50% of dose |
| > 4 x ULN | OMIT Epirubicin dose |
Renal Impairment
Cyclophosphamide: Renal failure may lead to the reduced excretion of metabolites and increased toxicity. Significant falls in clearance (25-80%) with increased exposure have been documented in patients with renal impairment. Dose reduction (25- 50%) should be considered in patients with mild to moderate renal impairment. Patients with moderate renal impairment receiving high doses or severe renally impaired patients (CrCl < 10 mL/min) are at particular risk and should be treated at a reduced dose and with extreme caution.
Epirubicin: Adjust dose with severe renal impairment (creatinine > 440 μmol/L).
F - Adverse Effects
Refer to cyclophosphamide, EPIrubicin drug monograph(s) for additional details of adverse effects
Most Frequently Occurring Adverse Effects
- Nausea and vomiting
- Cystitis
- Myelosuppression
- Cardiotoxicity
- Vesicant
- Stomatitis and diarrhea
- Alopecia
H - Drug Administration and Special Precautions
Refer to cyclophosphamide, EPIrubicin drug monograph(s) for additional details
I - Recommended Clinical Monitoring
Recommended Clinical Monitoring
- Clinical toxicity assessment (including stomatitis, cardiotoxicity, local toxicity, cystitis)
- CBC before each cycle
- Baseline and regular liver function tests
- Baseline and regular renal function tests and urinalysis
- Cardiac examination especially with risk factors (including prior therapy with Doxorubicin, Mitoxantrone, or other cardiotoxic drug), or a cumulative epirubicin dose of > 900mg/m2
- Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
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K - References
Findlay BP, Walker-Dilks C. Epirubicin, alone or in combination chemotherapy, for metastatic breast cancer. Provincial Breast Cancer Disease Site Group and Provincial Systemic Treatment Disease Site Group. Cancer Prev Control 1998 June; 2(3): 140-6.
Heidemann E, Steinke B, Harlapp J, et al. Randomized clinical trial comparing mitoxantron with doxorabicin, and with epirubicin, each combined with cyclophosphamide in the first line treatment of patients with metastatic breast cancer. Oncol 1990; 13: 24-7.
October 2017 Updated antiemetic classification
L - Other Notes
Epirubicin is covered under the CCO New Drug Funding Program for the treatment of neoadjuvant non-metastatic or adjuvant breast cancer only, but not for metastatic breast cancer.
M - Disclaimer
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
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Last Updated: July 27, 2026
