Knowledge (XXG)

EPOCH (chemotherapy)

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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
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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,
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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
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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.
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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).
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Dose escalation above the starting doses in case of good patient's chemotherapy tolerability applies simultaneously to etoposide, doxorubicin and cyclophosphamide.
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Martin Gutierrez, Bruce A. Chabner, Debra Pearson, Seth M. Steinberg, Elaine S. Jaffe, Bruce D. Cheson, Antonio Fojo, Wyndham H. Wilson (1 November 2000).
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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
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Dose de-escalation below the starting doses in case of poor patient's chemotherapy tolerability applies to cyclophosphamide only.
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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).
444: 382: 155: 503:"Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas: a pharmacodynamic approach with high efficacy" 440:"Role of a Doxorubicin-Containing Regimen in Relapsed and Resistant Lymphomas: An 8-Year Follow-Up Study of EPOCH" 315: 31: 81: 27: 543: 480: 418: 23: 60: 524: 461: 399: 378:"EPOCH chemotherapy: toxicity and efficacy in relapsed and refractory non-Hodgkin's lymphoma" 314:
from the first day after the end of chemotherapy to the day of full blood count restoration (
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Twice a week a full blood count with white blood cell count (WBC) differential is obtained.
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count is > 25,000/μL, then the dose for the next course will remain the same.
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Index

chemotherapy regimen
treatment
non-Hodgkin's lymphoma
rituximab
Rituximab
CD20
monoclonal
antibody
B cells
malignant
Etoposide
topoisomerase inhibitor
Prednisolone
glucocorticoid
hormone
apoptosis
lysis
lymphocytes
Oncovin
vincristine
protein
tubulin
microtubules
mitosis
Cyclophosphamide
alkylating antineoplastic agent
Hydroxydaunorubicin
doxorubicin
intercalate
DNA

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