R-EPOCH is a cancer treatment that combines six chemotherapy drugs. Combination therapies often work better than single drugs because they each fight cancer cells in different ways.
The drugs in the R-EPOCH combination are:
R = Rituxan (rituximab)
E = Etopophos (
P = prednisone
O = Oncovin (
C = cyclophosphamide
H = doxorubicin hydrochloride (hydroxydaunorubicin)
R-EPOCH is primarily used to treat B-cell non-Hodgkin’s lymphoma. It may also be used alongside other drugs or therapies to treat other types of cancer.
Researchers are currently studying its use in the treatment of Hodgkin’s lymphoma and B-cell acute leukemia.
The first cycle of R-EPOCH is typically given in an inpatient or hospital setting. Subsequent cycles may be administered in an outpatient (infusion) location.
The type of infusion method used (IV push, IV infusion, or continuous infusion) will vary depending on the location of the treatment (inpatient vs. outpatient setting).
Be sure to talk with your doctor about your specific R-EPOCH treatment. Depending on your diagnosis and health, it may vary from what’s described below.
| Day 1 | Rituximab is given by intravenous (IV) infusion. |
|---|---|
| Days 1 to 4 | Etoposide, Vincristine, and Doxorubicin are given by IV as a continuous infusion over 24 hours over 4 days |
| Days 1 to 5 | Prednisone is taken by mouth every 12 hours during days 1 through 5. |
| Day 5 | Cyclophosphamide is given by IV infusion for 30 minutes on day 5 |
This chemotherapy regimen is usually repeated every 21 days.
Additional medications may be given as needed to:
- prevent nausea (given before treatment begins): Ondansetron (Zofran)
- treat nausea (during treatment): Prochlorperazine (Compazine), Lorazepam (Ativan)
- prevent allergic reactions (given before treatment begins): Acetaminophen (Tylenol) and Diphenhydramine (Benadryl) will be given before rituximab infusion
- treat allergic reactions during treatment: Acetaminophen (Tylenol), Diphenhydramine (Benadryl), Meperidine (Demerol)
- boost your immune system (given after treatment):
Neupogen (filgrastim ) or something similar is given as a subcutaneous injection starting the first day after treatment.- Neulasta (pegfilgrastim) or something similar is given as a subcutaneous injection or applied as a patch on the skin once per cycle.
Common side effects that may occur with R-EPOCH include but are not limited to:
| Side effect | What to do |
|---|---|
| Decreased red and white blood cell counts (can cause bruising, prevent clotting, and weaken your immune system) | – Your infusion clinic will monitor your labs. – Follow their instructions on blood draw appointments |
| Fatigue | – Don’t exert yourself – rest when tired – eat and drink – ask for help |
| Increased risk of infection | – wash hands frequently – avoid contact with others who are sick – notify your doctor if you have a fever, chills, or cough |
| Nausea/vomiting | – stay hydrated – take your prescribed anti-nausea medication – eat smaller, more frequent meals |
| Alopecia (hair loss) | – use a hat or head covering to protect against the sun and cold temperatures |
| Mucositis(irritation of the digestive system), may cause sores in the mouth, throat, or lips | – brush your teeth gently – rinse 3 to 4 times daily with warm salt water (1/8 teaspoon salt to 1 cup of water) – use prescribed pain medications |
| Tumor lysis syndrome | – drink lots of fluids – urinate often – take prescribed preventive medications |
| Hemorrhagic cystitis (inflamed bladder, blood may be seen in urine) | – stay hydrated (up to 2 liters of fluid per day) – urinate frequently |
| Changes in urine color (red or orange colored) | – stay well hydrated – include high fiber foods – be as active as possible |
| Insomnia (difficulty sleeping) | – take prescribed oral steroid medication in the morning – avoid napping during the day – avoid caffeine and alcohol before bedtime – exercise if you’re able to |
| Peripheral neuropathy(numbness or tingling in your hands, toes, or feet) | – notify your doctor or infusion clinic |
Hemorrhagic cystitis(inflamed bladder; blood may be seen in urine) | – you may have tests to assess your heart function during treatment. Notify your doctor immediately if you have shortness of breath, difficulty breathing when lying down, or chest pain |
Call your doctor if you experience any of the following symptoms following a treatment cycle:
- a fever of 100.5° F (38° C) or greater
- bleeding or unusual bruising.
- burning and/or pain when urinating.
- no bowel movement in 2 to 3 days
- loose, watery stools (4 or more watery stools in 24 hours)
- nausea and vomiting, unable to keep down fluids
- pain not controlled by your current medications
- red, painful sores or a white coating in your mouth
- shaking and chills