1800 202 8726
Chemotherapy regimen — SCLC

The EP Regimen — Etoposide and Carboplatin for Small Cell Lung Cancer

EP is the chemotherapy regimen used for small cell lung cancer. It combines two drugs given on three consecutive days each cycle, followed by a rest period before the next round. This page explains what the drugs are, how the schedule works, and what to expect.

  • Two drugs, one regimen — EP pairs etoposide with a platinum drug — carboplatin or cisplatin — chosen based on your kidney function and other individual factors.
  • Three treatment days per cycle — Etoposide is given on days one, two, and three. The platinum drug is added on day one only.
  • Rest period between cycles — Days four to twenty-one are a rest period for recovery. The next cycle begins around day twenty-two.
  • Four to six cycles is typical — The exact number depends on how your cancer responds and how well you tolerate each cycle.

Medically reviewed by Dr. Owais Mohammed, Medical Oncologist · Last reviewed September 2026

Prescription-only medicine. EP is a prescription-only chemotherapy regimen that must be prescribed and supervised by a qualified oncologist and specialist team. It cannot be started, modified, or continued on the basis of anything read online or in this article. Nothing on this page is a recommendation to use this medicine. It is not suitable for most patients — see "Who this is not for" below.

Ask about your own treatment

A senior medical oncologist reviews what you send and replies in writing.

Reply within 2 working hours
Reviewed by a senior medical oncologist
Confidential. No commitment to start treatment.

EP is a chemotherapy regimen for small cell lung cancer. It combines two drugs: etoposide and carboplatin (or cisplatin). Etoposide is given on three consecutive days of each cycle, with the platinum drug on day one. A course typically runs for four to six cycles, each spaced approximately three weeks apart.

What does EP stand for, and what are the two drugs?

EP
The shorthand name for this regimen. It stands for etoposide plus a platinum drug — either carboplatin or cisplatin. Which platinum is used depends on your kidney function and other individual factors your oncologist considers.
Etoposide
A chemotherapy drug that works by blocking an enzyme called topoisomerase II. Cancer cells need this enzyme to copy their DNA. When the enzyme is blocked, dividing cells cannot complete that process and eventually die.
Carboplatin
A platinum-based chemotherapy drug. Carboplatin is more commonly paired with etoposide in India than cisplatin because it is generally better tolerated by the kidneys.
Cisplatin
The original platinum partner in EP. It may be used instead of carboplatin depending on your kidney function, hearing, and other clinical factors your oncologist weighs before prescribing.
Small cell lung cancer (SCLC)
A fast-growing type of lung cancer that starts in neuroendocrine cells. NCCN, ASCO, and ESMO all include EP as a standard first-line chemotherapy option for both limited-stage and extensive-stage SCLC.

Why is etoposide given on three days in a row?

Etoposide works by attacking cells at a specific point in the process of dividing. Giving it on three consecutive days increases the chance of catching more cancer cells at that vulnerable moment.

After the three treatment days, the cycle enters a rest period of roughly three weeks. This allows your bone marrow and healthy tissues to recover before the next cycle begins.

The combination of three treatment days followed by the rest period is what oncologists call a 21-day cycle. Your team may describe your course as 'four cycles of EP' or 'six cycles of EP', referring to this repeating pattern.

What happens on each day of a cycle?

  1. Before cycle 1 begins

    Blood tests check your kidney function, liver, and blood counts. Your oncologist reviews the results before giving the go-ahead. Anti-nausea medicines are prescribed before treatment starts.

  2. Day 1

    Carboplatin (or cisplatin) is given by intravenous infusion, usually followed by etoposide. Day 1 is the longest appointment of the cycle. IV fluids are given alongside the platinum drug to protect the kidneys.

  3. Days 2 and 3

    Etoposide infusion only. These visits are shorter than day 1. Anti-nausea medication continues on these days.

  4. Days 4 to 21 — the rest period

    No infusions. You go home and recover. Your team will tell you what signs to watch for — particularly fever, unusual bruising, or breathlessness — and when to call them.

  5. Before the next cycle

    Blood counts are checked again. If counts are adequate and you are well enough, the next cycle begins around day 22. If counts are low, your team may delay the start by a few days.

Who is EP chemotherapy not suitable for?

EP is not given to everyone diagnosed with lung cancer. Eligibility is decided by an oncologist based on your individual test results, kidney function, blood counts, and overall fitness.

EP is generally not used in:

  • People with non-small cell lung cancer, where different regimens are standard
  • People with severely reduced kidney function, as both carboplatin and cisplatin are cleared by the kidneys
  • People whose blood counts are already significantly reduced before treatment begins
  • Pregnancy — etoposide and platinum drugs are harmful to a developing baby
  • People whose general health or performance status would not allow them to safely receive intravenous chemotherapy

Pre-existing significant nerve damage may also influence which platinum drug, cisplatin or carboplatin, is the safer option for a particular patient. Your oncologist decides eligibility on the individual case.

How many cycles of EP are usually given?

A course of EP typically runs for four to six cycles. This is a range rather than a fixed number — the exact count depends on how your cancer is responding and how well you are tolerating the treatment.

Your oncologist will review scan and blood results during the course. If the cancer is responding and side effects are manageable, treatment continues toward the planned number of cycles.

If a cycle needs to be delayed or adjusted, that is a clinical decision based on your results at that point — not necessarily a sign that treatment is not working.

What side effects are most common with EP?

The most commonly reported effects involve the blood. Both etoposide and platinum drugs suppress the bone marrow, which means your white blood cell count falls after each cycle. A low count raises your infection risk, and your team will explain what signs to watch for and when to call.

Nausea is common, particularly on and after day 1 when the platinum drug is given. Anti-nausea medicines are given routinely as part of the infusion and prescribed for home use between cycles.

Hair loss occurs in most people taking etoposide. It is temporary — hair regrows after treatment ends.

Platinum drugs, particularly cisplatin, can affect the kidneys and cause tingling or numbness in the hands and feet. Your team monitors kidney function at each cycle. Tell them promptly about any numbness, tingling, or ringing in your ears.

Questions people ask before starting EP

Will I definitely lose my hair?

Hair loss is very common with etoposide and affects most people who take it. It usually begins two to three weeks after the first cycle and involves the scalp as well as body hair. Hair regrows after treatment ends, though texture or colour may differ temporarily. Your team can connect you with support for this if it would help.

Can EP be given as day care, or will I need to stay in hospital?

For most people, EP is given as an outpatient or day care infusion — you come in for the infusion and go home the same day. Day 1 is the longest visit because of the platinum infusion and IV fluids. Days 2 and 3 are typically shorter. Whether day care is available in your specific situation depends on your centre and your clinical condition at the time.

Why is my oncologist recommending carboplatin rather than cisplatin?

Both are platinum drugs used in EP and both are considered standard options by NCCN and ESMO. Carboplatin is generally better tolerated by the kidneys and causes less nausea than cisplatin. Cisplatin may be chosen in specific situations where there is a clinical reason to prefer it. The choice is your oncologist's decision based on your individual test results and health profile, not a reflection of which drug is stronger.

What should I do if I develop a fever during the rest period?

A fever during chemotherapy is not something to wait on. It can be a sign of neutropenic sepsis — a medical emergency caused by very low white blood cell counts combined with infection. Your team will give you a specific temperature threshold and clear instructions before you leave after each cycle. If your temperature reaches that level, go to hospital the same day rather than waiting for a callback or a scheduled appointment.

Will EP affect my fertility?

Both etoposide and platinum drugs can affect fertility in men and women. For women, they may cause temporary or lasting changes to ovarian function. For men, sperm production may be reduced during and after treatment. If fertility preservation matters to you, raise it with your oncologist before starting — options exist but they need to be arranged before chemotherapy begins, not during or after. Do not assume the conversation is too early to have.

What happens if a cycle has to be delayed?

Cycle delays are a normal part of managing chemotherapy safely. If your blood counts are too low on the day a cycle is due, your team may postpone it by a few days to allow your bone marrow to recover. A delay does not mean the treatment is failing or that your cancer is worsening — it means your team is managing the course in a way that keeps you safe. Your oncologist will explain the reason at the time.

Explore 82 more How Chemotherapy Is Given: Regimens, Cycles & Infusion Days topics

HUB — Chemotherapy Regimens

HUB — Cycles, Schedules and What Happens on Infusion Day

All How Chemotherapy Is Given: Regimens, Cycles & Infusion Days →

Common questions

Frequently asked questions

Is EP the standard treatment for all small cell lung cancer?

EP is recommended by NCCN, ASCO, and ESMO as a standard first-line chemotherapy regimen for both limited-stage and extensive-stage SCLC. However, not every person with SCLC will receive EP — your oncologist considers kidney function, overall fitness, and other individual factors before deciding on the specific regimen and which platinum drug to use. Some people are offered a different approach based on their clinical profile.

Can immunotherapy be added to EP?

In some cases, immunotherapy drugs have been evaluated alongside EP-based chemotherapy for extensive-stage SCLC, and this combination appears in guidance from bodies including NCCN. Whether immunotherapy is part of your course depends on your specific situation, the stage of your cancer, and your oncologist's assessment. If it is being added, your team will explain what the drug is, what additional monitoring it requires, and what to watch for.

Will I be able to eat normally during EP treatment?

Nausea is common with EP, particularly on and after day 1 of each cycle when the platinum drug is given. Anti-nausea medicines are a routine part of the infusion and prescribed for home use between cycles. Most people find nausea is worst in the first few days after each treatment day and improves during the rest period. Tell your team if the medicines you have been given are not controlling it — adjustments can usually be made.

What does a low blood count mean for my next cycle?

A low white blood cell count after a cycle is expected — it is part of how chemotherapy works. If the count is too low on the day your next cycle is due, your team may delay the cycle by a few days to allow your bone marrow to recover. This is a normal safety measure, not a sign something has gone wrong. Your team may also prescribe a growth factor injection to support bone marrow recovery between cycles.

Is there anything I should avoid while on EP?

Tell your oncologist and pharmacist about every medicine, supplement, and herbal product you are taking before starting EP. Some interact with chemotherapy drugs. Alcohol is generally best avoided around treatment days as it can worsen nausea and fatigue. Your team is the right source of specific guidance based on your full medication list and your overall health — do not stop or start anything without checking first.

How will my oncologist know whether EP is working?

Response is assessed through imaging scans, blood results, and your symptoms. Scans are typically done after a set number of cycles rather than after every one — waiting allows enough time for the treatment to show its effect on the tumour. If you feel your symptoms are worsening at any point during the course, tell your team promptly. Do not wait for the next scheduled appointment. Any new or worsening breathlessness, pain, or other change between cycles is worth reporting the same day.

Full index

Browse all 579 chemotherapy topics

Every page in this section, grouped by the part of treatment it belongs to. Open a group to see what is in it.

Before You Start: Tests, Ports & Fertility42
Blood Counts, Infection, Fever & Emergencies73

Anaemia & Low Haemoglobin

HUB — Low Blood Counts, Infection and Fever During Chemotherapy

Chemotherapy and Supportive Medicines by Name75

Chemotherapy Drugs by Name

HUB — Chemotherapy Drugs by Name

HUB — Generic, Branded and Biosimilar Chemotherapy in India

HUB — Supportive Medicines Used With Chemotherapy

Chemotherapy at CION Cancer Clinics1
Chemotherapy by Cancer Type and Special Situations5

Special Populations & Comorbidities

HUB — Chemotherapy in Special Situations

Chemotherapy in Hyderabad: Cost, Centres & Access93

HUB — Choosing a Chemotherapy Centre and Safe Administration

Common Side Effects and How They Are Managed78
Food, Diet, Hydration & Household Safety6
How Chemotherapy Is Given: Regimens, Cycles & Infusion Days85

Other Ways Chemotherapy Is Given

HUB — Cycles, Schedules and What Happens on Infusion Day

Is It Working, Finishing Chemotherapy & Survivorship7

Is It Working? Response & Scans

HUB — Is Chemotherapy Working? Scans and Response

HUB — When Chemotherapy Stops Working

Nerve, Skin, Heart, Kidney and Cognitive Effects5

Skin, Nails & Hand-Foot Syndrome

Heart, Lung & Organ Toxicity

HUB — Effects on the Heart, Kidneys, Liver and Nerves

Understanding Chemotherapy, Myths & Trials97

HUB — Chemotherapy Myths and Alternative Treatment Claims

HUB — Clinical Trials in Cancer Treatment

HUB — What Is Chemotherapy and Why Has It Been Advised?

Work, Family, Relationships and Emotional Support12