EPOCH (chemotherapy)
EPOCH is an intensive chemotherapy regimen intended for treatment of aggressive non-Hodgkin's lymphoma.[1][2]
It is often combined with rituximab. In this case it is called R-EPOCH or EPOCH-R.The R-EPOCH regimen consists of:
- Rituximab: an anti-CD20 monoclonal antibody, which has the ability to kill B cells, be they normal or malignant;
- Etoposide: a topoisomerase inhibitor from the group of epipodophyllotoxins;
- Prednisolone: a glucocorticoid hormone that can cause apoptosis and lysis of both normal and malignant lymphocytes;
- Oncovin, also known as vincristine: a vinca alkaloid that binds to the protein tubulin, thereby preventing the formation of microtubules and mitosis;
- Cyclophosphamide: an alkylating antineoplastic agent;
- Hydroxydaunorubicin, also known as doxorubicin: an anthracycline antibiotic that is able to intercalate DNA, damaging it and preventing cell division.
Dosing regimen[edit]
Drug | Dose | Mode | Days |
---|---|---|---|
Rituximab | 375 mg/m2 | IV infusion | Day 1 |
Etoposide | 50 mg/m2 | IV continuous infusion over 24 h | Days 1–4 |
Prednisolone | 60 mg/m2 | By mouth, twice a day (PO BID) | Days 1–5 |
Oncovin: vincristine | 0.4 mg/m2 | IV continuous infusion over 24 h | Days 1–4 |
Cyclophosphamide | 750 mg/m2 | IV bolus given over 15 min | Day 5 |
Hydroxydaunorubicin: doxorubicin | 10 mg/m2 | IV continuous infusion over 24 h | Days 1–4 |
This regimen requires the use of prophylactic antibiotics to prevent infectious complications, as well as the use of colony-stimulating factors (G-CSF) from the first day after the end of chemotherapy to the day of full blood count restoration (ANC > 1000/
There is also an improved version of the regimen. In this version the chemotherapy dose varies from cycle to cycle depending on the patient's ability to tolerate chemotherapy and the degree of neutropenia and thrombocytopenia observed in this patient after each cycle. This approach is called "dose-adjusted EPOCH", or "DA-EPOCH" (DA-EPOCH-R, DA-R-EPOCH or R-DA-EPOCH are used when rituximab is included).
Dose change rules are as follows:[citation needed]
Twice a week a full blood count with white blood cell count (WBC) differential is obtained.
Dose escalation above the starting doses in case of good patient's chemotherapy tolerability applies simultaneously to etoposide, doxorubicin and cyclophosphamide.
Dose de-escalation below the starting doses in case of poor patient's chemotherapy tolerability applies to cyclophosphamide only.
If the nadir ANC > 500/
If the nadir ANC < 500/
If the nadir ANC < 500/
References[edit]
- ^ W H Wilson, G Bryant, S Bates, A Fojo, R E Wittes, S M Steinberg, D R Kohler, E S Jaffe, J Herdt, B D Cheson (1 August 1993). "EPOCH chemotherapy: toxicity and efficacy in relapsed and refractory non-Hodgkin's lymphoma". Journal of Clinical Oncology. 11 (8): 1573–1582. doi:10.1200/JCO.1993.11.8.1573. PMID 7687667. Retrieved 24 October 2020.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Martin Gutierrez, Bruce A. Chabner, Debra Pearson, Seth M. Steinberg, Elaine S. Jaffe, Bruce D. Cheson, Antonio Fojo, Wyndham H. Wilson (1 November 2000). "Role of a Doxorubicin-Containing Regimen in Relapsed and Resistant Lymphomas: An 8-Year Follow-Up Study of EPOCH". Journal of Clinical Oncology. 18 (21): 3633–3642. doi:10.1200/JCO.2000.18.21.3633. PMID 11054436. Retrieved 24 October 2020.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Wyndham H. Wilson, Michael L. Grossbard, Stefania Pittaluga, Diane Cole, Deborah Pearson, Nicole Drbohlav, Seth M. Steinberg, Richard F. Little, John Janik, Martin Gutierrez, Mark Raffeld, Louis Staudt, Bruce D. Cheson, Dan L. Longo, Nancy Harris, Elaine S. Jaffe, Bruce A. Chabner, Robert Wittes, Frank Balis (15 April 2002). "Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas: a pharmacodynamic approach with high efficacy". Blood. 99 (8): 2685–2693. doi:10.1182/blood.V99.8.2685. PMID 11929754. Retrieved 24 October 2020.
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: CS1 maint: multiple names: authors list (link)