# Epirubicin

Source: https://onco.cc/drugs/epirubicin/  
OnCo record `epirubicin` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Epirubicin (Ellence) is a close relative of doxorubicin used mainly after breast cancer surgery when lymph nodes are involved, and in stomach cancer regimens; it is a little kinder to the heart.

## Summary

Epirubicin was approved by the FDA in 1999 as a component of adjuvant therapy for axillary node-positive breast cancer, based on the Canadian MA.5 (CEF versus CMF) and French FASG trials in which epirubicin-containing regimens improved relapse-free and overall survival. Outside the US it has been used far more widely since the 1980s, including in the ECF/EOX regimens for gastro-oesophageal cancer (REAL-2) and in FEC-docetaxel sequences for breast cancer. Cardiotoxicity is cumulative-dose dependent (the label caps lifetime exposure at 900 mg/m2), secondary acute myeloid leukaemia is a recognised late effect, and it is a vesicant.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-10
- Also known as: Pharmorubicin
- Tags: nci-list; generic
- Brand: Ellence
- Modality: Anthracycline (topoisomerase II inhibitor)
- Mechanism: 4'-epimer of doxorubicin; intercalates DNA and inhibits topoisomerase II, with less cardiotoxicity per milligram than doxorubicin.
- Approvals: US 1999: Adjuvant therapy for axillary node-positive breast cancer

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Epirubicin
- US label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=epirubicin
- NCI drug page: https://www.cancer.gov/about-cancer/treatment/drugs/epirubicinhydrochloride

## Connected records

- drugs: [Doxorubicin](https://onco.cc/drugs/doxorubicin/)
- cancers: [Early triple-negative breast cancer](https://onco.cc/cancers/tnbc-early/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Heart function after anthracyclines, trastuzumab and chest radiotherapy](https://onco.cc/technologies/cardiotoxicity-surveillance-recovery/), [Protecting the heart during anthracycline treatment: dexrazoxane, beta blockers and ACE inhibitors](https://onco.cc/technologies/anthracycline-cardioprotection/), [The heart after anthracyclines and chest radiotherapy in childhood](https://onco.cc/technologies/rejuv-paed-heart/), [Topoisomerase-I inhibitors (and ADC payloads)](https://onco.cc/technologies/topoisomerase-inhibitors/)
- companies: [Pfizer (incl. Seagen)](https://onco.cc/companies/pfizer/)
- trials: [A Clinical Study of Sacituzumab Tirumotecan (Sac-TMT, MK-2870) in People With Breast Cancer (MK-2870-032)](https://onco.cc/trials/nct06966700/), [A Multi-center, Randomized, Open-label, Phase III Study Comparing PD-1 Inhibitor Combined With Antivascular Therapy and Anthracycline/Taxane-based Adjuvant Chem](https://onco.cc/trials/nct05862064/), [A Phase III Randomised Study to Evaluate Dato-DXd and Durvalumab for Neoadjuvant/Adjuvant Treatment of Triple-Negative or Hormone Receptor-low/HER2-negative Breast Cancer](https://onco.cc/trials/nct06112379/), [Adjuvant Chemotherapy for Triple Negative Breast Cancer Patients With Residual Disease After Neoadjuvant Chemotherapy](https://onco.cc/trials/nct04437160/), [Adjuvant Treatment of EC Followed by Taxane +/- Carboplatin in Triple-Negative Breast Cancer](https://onco.cc/trials/nct02455141/), [ALEXANDRA / IMpassion030](https://onco.cc/trials/impassion030/), [Carboplatin Intensified Chemotherapy for TRIple NEgative Breast Cancer(CITRINE)](https://onco.cc/trials/nct04296175/), [Endovascular Brachytherapy Combined With Stent Placement and TACE for HCC With Main Portal Vein Tumor Thrombus](https://onco.cc/trials/nct02971345/), [FLOT4-AIO](https://onco.cc/trials/flot4/), [GeparDouze / NSABP B-59](https://onco.cc/trials/gepardouze/), [MicroRNA Profiles in Triple Negative Breast Cancer](https://onco.cc/trials/nct04771871/), [Nab-paclitaxel Plus Carboplatin Versus Nab-paclitaxel Plus Epirubicin in the Neoadjuvant Therapy for Breast Cancer](https://onco.cc/trials/nct04138719/), [Neoadjuvant Darolutamide Alone or in Combination With Standard Therapy for Stage II-IIIA, AR+, TNBC](https://onco.cc/trials/nct07016399/), [Neoadjuvant Study of DV in Combination Toripalimab or Sequence Chemotherapy in HR-negative, HER2 Low-expressing Breast Cancer](https://onco.cc/trials/nct06227117/), [Non-Inferiority Study on MRNA-lncRNA Model in Low-Risk Triple-Negative Breast Cancer Patients](https://onco.cc/trials/nct06795503/), [NordicTrip, a Translational Study of Preoperative Chemotherapy in TNBC](https://onco.cc/trials/nct04335669/), [Paclitaxel Oral Solution in Triple Neagtive Breast Cancer Neoadjuvant Therapy: A Dose-Finding Study](https://onco.cc/trials/nct07739485/), [Precise Chemoresection in Low-grade NMIBC Using Drug Screens in Patient-derived Organoids](https://onco.cc/trials/nct06227065/), [Randomized Phase III Trial Comparing Sequential Administration of FE75C Followed by Docetaxel Versus Paclitaxel as Adjuvant Chemotherapy in Axillary Lymph Node (+) Breast Cancer](https://onco.cc/trials/nct00431080/), [Safety and Efficacy Comparison of Docetaxel and Ixabepilone in Non Metastatic Poor Prognosis Breast Cancer](https://onco.cc/trials/nct00630032/), [Sequential Administration of FE75C and Docetaxel Versus Docetaxel/Cyclophosphamide in HER-2 Negative, Node Positive Breast Cancer](https://onco.cc/trials/nct01985724/), [Six vs 12 Months of Trastuzumab With Docetaxel Following FEC as Adjuvant Treatment in N+ Breast Cancer](https://onco.cc/trials/nct00615602/), [Study of Camrelizumab Plus Apatinib and Chemotherapy as Neoadjuvant Therapy in Participants With Triple Negative Breast Cancer (TNBC)](https://onco.cc/trials/nct05447702/), [Study of Patritumab Deruxtecan Plus Pembrolizumab With Other Anticancer Agents in Participants With High-Risk Early-Stage Triple-Negative or Hormone Receptor-Low Positive/HER-2 Negative Breast Cancer (MK-1022-010, HERTHENA-Breast-03)](https://onco.cc/trials/nct06797635/), [Study of Pembrolizumab (MK-3475) Versus Placebo in Combination With Neoadjuvant Chemotherapy & Adjuvant Endocrine Therapy in the Treatment of Early-Stage Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative (ER+/HER2-) Breast Cancer (MK-3475-756/KEYNOTE-756)](https://onco.cc/trials/nct03725059/), [TA(E)C-GP Versus A(E)C-T for the High Risk TNBC Patients and Validation of the mRNA-lncRNA Signature](https://onco.cc/trials/nct02641847/), [to Evaluate Efficacy and Safety of HLX10 in Combination With Chemotherapy Versus Placebo in Combination With Chemotherapy as Neoadjuvant Therapy and HLX10 Versu](https://onco.cc/trials/nct04301739/), [To Evaluate the Efficacy and Safety of Disitamab Vedotin Combined With Toripalimab Sequential Chemotherapy as Neoadjuvant Treatment in Patients With HR-positive, HER2-low Breast Cancer](https://onco.cc/trials/nct06389006/), [TRAIN-2](https://onco.cc/trials/train-2/), [Trial Studying Chemotherapy in Nigerian Women With Triple Negative Breast Cancer](https://onco.cc/trials/nct06291064/)
- terms: [Hair loss and scalp cooling with breast cancer chemotherapy](https://onco.cc/terms/hair-loss-and-scalp-cooling-breast/)
- key papers: [FLOT4-AIO: perioperative FLOT versus ECF/ECX for resectable gastric or gastro-oesophageal junction adenocarcinoma](https://onco.cc/key-papers/paper-flot4-lancet-2019/)

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