EPOCH (chemotherapy)

Last updated

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:

  1. Rituximab: an anti-CD20 monoclonal antibody, which has the ability to kill B cells, be they normal or malignant;
  2. Etoposide: a topoisomerase inhibitor from the group of epipodofyllotoxins;
  3. Prednisolone: a glucocorticoid hormone that can cause apoptosis and lysis of both normal and malignant lymphocytes;
  4. Oncovin, also known as vincristine: a vinca alkaloid that binds to the protein tubulin, thereby preventing the formation of microtubules and mitosis;
  5. Cyclophosphamide: an alkylating antineoplastic agent;
  6. Hydroxydaunorubicin, also known as doxorubicin: an anthracycline antibiotic that is able to intercalate DNA, damaging it and preventing the cell division.

Dosing regimen

DrugDoseModeDays
Rituximab 375 mg/m2 IV infusion Day 1
Etoposide 50 mg/m2IV continuous infusion over 24 hDays 1–4
Prednisolone 60 mg/m2By mouth, twice a day (PO BID)Days 1–5
Oncovin: vincristine 0.4 mg/m2IV continuous infusion over 24 hDays 1–4
Cyclophosphamide 750 mg/m2IV bolus given over 15 minDay 5
Hydroxydaunorubicin: doxorubicin 10 mg/m2IV continuous infusion over 24 hDays 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/μL).

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/μL, then the doses of etoposide, doxorubicin, and cyclophosphamide for the next cycle are all increased by 20% over the doses used in the previous cycle.

If the nadir ANC < 500/μL on one or two blood checks, but ANC rises above 500 at the time of third check (i.e. the duration of agranulocytosis is less than nine days), and the nadir of platelet count is > 25,000/μL, then the dose for the next course will remain the same.

If the nadir ANC < 500/μL for 10 days or more, or if the nadir platelet count at every time falls below 25,000/μL, then the doses of etoposide, doxorubicin and cyclophosphamide are reduced by 20% below the doses used in the previous cycle, but doxorubicin and etoposide should not be reduced below the initial dose (dose in first course). [3]

Related Research Articles

Burkitt lymphoma Medical condition

Burkitt lymphoma is a cancer of the lymphatic system, particularly B lymphocytes found in the germinal center. It is named after Denis Parsons Burkitt, the Irish surgeon who first described the disease in 1958 while working in equatorial Africa. The overall cure rate for Burkitt lymphoma in developed countries is about 90%, but worse in low-income countries. Burkitt lymphoma is uncommon in adults, in whom it has a worse prognosis.

Anaplastic large-cell lymphoma Medical condition

Anaplastic large cell lymphoma (ALCL) refers to a group of non-Hodgkin lymphomas in which aberrant T cells proliferate uncontrollably. Considered as a single entity, ALCL is the most common type of peripheral lymphoma and represents ~10% of all peripheral lymphomas in children. The incidence of ALCL is estimated to be 0.25 cases per 100,000 people in the United States of America. There are four distinct types of anaplastic large cell lymphomas that on microscopic examination share certain key histopathological features and tumor marker proteins. However, the four types have very different clinical presentations, gene abnormalities, prognoses, and/or treatments.

Cyclophosphamide Medication used as chemotherapy and to suppress the immune system

Cyclophosphamide (CP), also known as cytophosphane among other names, is a medication used as chemotherapy and to suppress the immune system. As chemotherapy it is used to treat lymphoma, multiple myeloma, leukemia, ovarian cancer, breast cancer, small cell lung cancer, neuroblastoma, and sarcoma. As an immune suppressor it is used in nephrotic syndrome, granulomatosis with polyangiitis, and following organ transplant, among other conditions. It is taken by mouth or injection into a vein.

Fludarabine

Fludarabine is a purine analogue and antineoplastic agent. It is generally used as its 5-O-phosphorylated form known as fludarabine phosphate, sold under the brand name Fludara among others. It is a chemotherapy medication used in the treatment of leukemia and lymphoma. These include chronic lymphocytic leukemia, non-Hodgkin's lymphoma, acute myeloid leukemia, and acute lymphocytic leukemia. It is given by injection into a vein or by mouth.

CHOP is the acronym for a chemotherapy regimen used in the treatment of non-Hodgkin lymphoma. CHOP consists of:

A chemotherapy regimen is a regimen for chemotherapy, defining the drugs to be used, their dosage, the frequency and duration of treatments, and other considerations. In modern oncology, many regimens combine several chemotherapy drugs in combination chemotherapy. The majority of drugs used in cancer chemotherapy are cytostatic, many via cytotoxicity.

Primary effusion lymphoma Medical condition

Primary effusion lymphoma (PEL) is classified as a diffuse large B cell lymphoma. It is a rare malignancy of plasmablastic cells that occurs in individuals that are infected with the Kaposi's sarcoma-associated herpesvirus. Plasmablasts are immature plasma cells, i.e. lymphocytes of the B-cell type that have differentiated into plasmablasts but because of their malignant nature do not differentiate into mature plasma cells but rather proliferate excessively and thereby cause life-threatening disease. In PEL, the proliferating plasmablastoid cells commonly accumulate within body cavities to produce effusions, primarily in the pleural, pericardial, or peritoneal cavities, without forming a contiguous tumor mass. In rare cases of these cavitary forms of PEL, the effusions develop in joints, the epidural space surrounding the brain and spinal cord, and underneath the capsule which forms around breast implants. Less frequently, individuals present with extracavitary primary effusion lymphomas, i.e., solid tumor masses not accompanied by effusions. The extracavitary tumors may develop in lymph nodes, bone, bone marrow, the gastrointestinal tract, skin, spleen, liver, lungs, central nervous system, testes, paranasal sinuses, muscle, and, rarely, inside the vasculature and sinuses of lymph nodes. As their disease progresses, however, individuals with the classical effusion-form of PEL may develop extracavitary tumors and individuals with extracavitary PEL may develop cavitary effusions.

Cyclophosphamide Methotrexate Fluorouracil (CMF) is a commonly used regimen of breast cancer chemotherapy that combines three anti-cancer agents: cyclophosphamide, methotrexate, and 5-fluorouracil (5-FU).

Diffuse large B-cell lymphoma Type of lymphoma

Diffuse large B-cell lymphoma (DLBCL) is a cancer of B cells, a type of lymphocyte that is responsible for producing antibodies. It is the most common form of non-Hodgkin lymphoma among adults, with an annual incidence of 7–8 cases per 100,000 people per year in the US and UK. This cancer occurs primarily in older individuals, with a median age of diagnosis at ~70 years, although it can occur in young adults and, in rare cases, children. DLBCL can arise in virtually any part of the body and, depending on various factors, is often a very aggressive malignancy. The first sign of this illness is typically the observation of a rapidly growing mass or tissue infiltration that is sometimes associated with systemic B symptoms, e.g. fever, weight loss, and night sweats.

ABVD is a chemotherapy regimen used in the first-line treatment of Hodgkin lymphoma, replacing the older MOPP protocol. It consists of concurrent treatment with the chemotherapy drugs:

Pixantrone Chemical compound

Pixantrone is an experimental antineoplastic (anti-cancer) drug, an analogue of mitoxantrone with fewer toxic effects on cardiac tissue. It acts as a topoisomerase II poison and intercalating agent. The code name BBR 2778 refers to pixantrone dimaleate, the actual substance commonly used in clinical trials.

Mantle cell lymphoma Medical condition

Mantle cell lymphoma (MCL) is a type of non-Hodgkin's lymphoma (NHL), comprising about 6% of NHL cases. There are only about 15,000 patients presently in the United States with mantle cell lymphoma. It is named for the mantle zone of the lymph nodes.

Hyper-CVAD is a chemotherapy regimen used to treat some forms of leukemia, high-grade non-Hodgkin lymphoma, and lymphoblastic leukemia.

CBV refers to Cytoxan (cyclophosphamide), BCNU (carmustine), and VP-16 (etoposide), three drugs in a chemotherapy regimen commonly given to lymphoma patients in conjunction with stem cell therapy.

ICE in the context of chemotherapy is an acronym for one of the chemotherapy regimens, used in salvage treatment of relapsed or refractory non-Hodgkin's lymphoma and Hodgkin lymphoma.

Primary mediastinal B-cell lymphoma Medical condition

Primary mediastinal B-cell lymphoma, abbreviated PMBL, is a rare type of lymphoma that forms in the mediastinum and predominantly affects young adults.

Plasmablastic lymphoma (PBL) is a type of large B-cell lymphoma recognized by the World Health Organization (WHO) in 2017 as belonging to a subgroup of lymphomas termed lymphoid neoplasms with plasmablastic differentiation. The other lymphoid neoplasms within this subgroup are: plasmablastic plasma cell lymphoma ; primary effusion lymphoma that is Kaposi's sarcoma-associated herpesvirus positive or Karposi's sarcoma-associated Herpesvirus negative; anaplastic lymphoma kinase-positive large B-cell lymphoma; and human herpesvirus 8-positive diffuse large B-cell lymphoma, not otherwise specified. All of these lymphomas are malignancies of plasmablasts, i.e. B-cells that have differentiated into plasmablasts but because of their malignant nature: fail to differentiate further into mature plasma cells; proliferate excessively; and accumulate in and injure various tissues and organs.

ESHAP is an acronym for relatively intensive chemotherapy regimen that is used for salvage therapy in relapsed or refractory lymphomas and Hodgkin's lymphoma. In combination with monoclonal antibody Rituximab it is called R-ESHAP or ESHAP-R.

FCM, or FMC in the context of chemotherapy is an acronym for a chemotherapy regimen that is often used in the treatment of indolent B cell non-Hodgkin's lymphomas.

"7+3" in the context of chemotherapy is an acronym for a chemotherapy regimen that is most often used today as first-line induction therapy in acute myelogenous leukemia, excluding the acute promyelocytic leukemia form, which is better treated with ATRA and/or arsenic trioxide and requires less chemotherapy.

References

  1. ↑ 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.CS1 maint: multiple names: authors list (link)
  2. ↑ 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.CS1 maint: multiple names: authors list (link)
  3. ↑ 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.CS1 maint: multiple names: authors list (link)
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.