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:
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Rituximab: an anti-
CD20 monoclonal
Monoclonality refers to the state of a line of cells that have been derived from a single clonal origin. Thus "monoclonal cells" can be said to form a single clone. The term ''monoclonal'' comes from the Ancient Greek ''monos'', meaning "alone" o ...
antibody, which has the ability to kill
B cell
B cells, also known as B lymphocytes, are a type of white blood cell of the lymphocyte subtype. They function in the humoral immunity component of the adaptive immune system. B cells produce antibody molecules which may be either secreted or ...
s, be they normal or
malignant;
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Etoposide: a
topoisomerase inhibitor from the group of epipodophyllotoxins;
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Prednisolone: a
glucocorticoid hormone that can cause
apoptosis
Apoptosis (from grc, ἀπόπτωσις, apóptōsis, 'falling off') is a form of programmed cell death that occurs in multicellular organisms. Biochemical events lead to characteristic cell changes (morphology) and death. These changes incl ...
and
lysis
Lysis ( ) is the breaking down of the membrane of a cell, often by viral, enzymic, or osmotic (that is, "lytic" ) mechanisms that compromise its integrity. A fluid containing the contents of lysed cells is called a ''lysate''. In molecular bio ...
of both normal and malignant
lymphocytes;
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Oncovin
Vincristine, also known as leurocristine and marketed under the brand name Oncovin among others, is a chemotherapy medication used to treat a number of types of cancer. This includes acute lymphocytic leukemia, acute myeloid leukemia, Hodgkin's ...
, also known as
vincristine: a vinca alkaloid that binds to the
protein tubulin, thereby preventing the formation of
microtubule
Microtubules are polymers of tubulin that form part of the cytoskeleton and provide structure and shape to eukaryotic cells. Microtubules can be as long as 50 micrometres, as wide as 23 to 27 nm and have an inner diameter between 11 an ...
s and
mitosis
In cell biology, mitosis () is a part of the cell cycle in which replicated chromosomes are separated into two new nuclei. Cell division by mitosis gives rise to genetically identical cells in which the total number of chromosomes is mainta ...
;
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Cyclophosphamide
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 ...
: an
alkylating antineoplastic agent;
#
Hydroxydaunorubicin
Doxorubicin, sold under the brand name Adriamycin among others, is a chemotherapy medication used to treat cancer. This includes breast cancer, bladder cancer, Kaposi's sarcoma, lymphoma, and acute lymphocytic leukemia. It is often used togeth ...
, also known as
doxorubicin: an anthracycline antibiotic that is able to
intercalate
Intercalation may refer to:
*Intercalation (chemistry), insertion of a molecule (or ion) into layered solids such as graphite
* Intercalation (timekeeping), insertion of a leap day, week or month into some calendar years to make the calendar foll ...
DNA, damaging it and preventing
cell division.
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Dosing regimen
This regimen requires the use of prophylactic
antibiotic
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...
s 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
Neutropenia is an abnormally low concentration of neutrophils (a type of white blood cell) in the blood. Neutrophils make up the majority of circulating white blood cells and serve as the primary defense against infections by destroying bacteria ...
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
Agranulocytosis, also known as agranulosis or granulopenia, is an acute condition involving a severe and dangerous lowered white blood cell count (leukopenia, most commonly of neutrophils) and thus causing a neutropenia in the circulating blood. ...
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
{{reflist
Chemotherapy regimens used in lymphoma