Information
Cyclophosphamide + Epirubicin + 5-Fluorouracil (CEF)1,55- Prechemo: CBC, Chem, LFTs, and CA 27–29. MUGA scan. 5-HT3 and dexamethasone 20 mg days 1 and 8. Oral 5-HT3 or phenothiazine days 2–7 and 9–14. Moderately to highly emetogenic.
- Cyclophosphamide 75 mg/m2/day: PO days 1–14. (25- and 50-mg tablets.) Taken with meals in morning or early afternoon for adequate excretion time.
- Epirubicin 60 mg/m2: IV push on days 1 and 8. Vesicant.
- 5-Flourouracil 500 mg/m2: IV on days 1 and 8.
- Side effects: Cyclophosphamide can cause rhinitis and irritation of nose and throat. Myelosuppression may be severe. Nausea and vomiting. Mucositis and diarrhea severe and dose-limiting. Cardiotoxicity is dose related, is cumulative, and may occur during months to years after cessation of therapy. Cyclophosphamide may increase the risk of cardiotoxicity. Dose reduce with liver dysfunction. Hemorrhagic cystitis, dysuria, and urinary frequency. Red-orange discoloration of urine. Epirubicin may cause “flare” reaction or streaking along vein during peripheral administration. If occurs, slow drug administration and increase free-flowing IV. Hyperpigmentation, photosensitivity, nail changes, and radiation recall occur. Alopecia. Hand-foot syndrome can be dose-limiting. SIADH. Photophobia, increased lacrimation, acute and chronic conjunctivitis, blepharitis, and blurred vision.
- Chair time: 1 hour on days 1 and 8. Repeat cycle every 28 days until progression.