epoch chemotherapy

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    EPOCH is an intensive chemotherapy regimen intended for treatment of aggressive non-Hodgkin's lymphoma.
    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



    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:
    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).


    References

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epoch chemotherapy

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EPOCH (chemotherapy) - Wikipedia

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 - NCI - National Cancer Institute

Each of the drugs in this combination is approved by the Food and Drug Administration (FDA) to treat cancer or conditions related to cancer. EPOCH is used to treat: Non-Hodgkin lymphoma …

R-EPOCH: Rituximab, Etoposide, Prednisone, Vincristine ...

Etoposide is a chemotherapy medicine known as a “topoisomerase II inhibitor.” This medicine is made from plants and works to stop fast growing cancer cells from dividing and making new …

EPOCH: Etoposide, Prednisone, Vincristine, …

What is etoposide (e-TOE-poe-side) and how does it work? Etoposide is a chemotherapy medicine known as a “plant alkaloid.” This medicine is made from plants and works to stop fast …

R-EPOCH Chemotherapy for Non-Hodgkin Lymphoma - Verywell …

Mar 13, 2023 · The R-EPOCH chemotherapy regimen and its variants, including DA-R-EPOCH, are tailored to treat people with specific types and subtypes of aggressive non-Hodgkin …

R-EPOCH Chemotherapy, Non-Hodgkin Lymphoma, Diffuse …

The EPOCH chemotherapy regimen is the gold standard for treatment of all B-cell non-Hodgkin lymphoma types. These include Burkitt lymphoma, chronic lymphocytic leukemia/small …

DA-EPOCH-R (Rituxan) for B-cell Lymphoma - ChemoExperts

Each of the medications in Dose-Adjusted EPOCH-R (DA-EPOCH-R) are designed to kill cancerous blood cells known as B-lymphocytes. Goals of therapy: DA-EPOCH-R is given to …

Definition of EPOCH regimen - NCI Dictionary of Cancer Terms

An abbreviation for a chemotherapy combination used to treat aggressive forms of non-Hodgkin lymphoma, including mantle cell lymphoma. It includes the drugs etoposide phosphate, …

EPOCH chemotherapy: toxicity and efficacy in relapsed and ... - PubMed

EPOCH chemotherapy was well tolerated and highly effective in patients who were resistant to or relapsed from the same drugs administered on a bolus schedule, suggesting that continuous …

EPOCH (Chemotherapy) - an overview | ScienceDirect Topics

The addition of etoposide, as in CHOEP or dose-adjusted EPOCH, is a reasonable approach for first-line chemotherapy; the ultimate goal should be for allogeneic transplant in first remission. …