Systemic Anti-Cancer Therapy Regimen Library
LYM NHL B-cell - DA-R-EPOCH [Dose-adjusted RITUximab, etoposide, prEDNIsone, vinCRISTine, CYCLOPHOSPHamide and DOXOrubicin] [9 levels]
Treatment Overview
Number of cycles: Minimum 6, maximum 8. Give 2 cycles beyond complete remission or stable disease.
First cycle is always given as LEVEL 1, subsequent cycle levels are determined by neutrophil and platelet counts as per Table:
First cycle is always given as LEVEL 1, subsequent cycle levels are determined by neutrophil and platelet counts (see Table above).
This may be used as Cycles 2 to 8.
Cycle 1 is always given as LEVEL 1.
This may be used as Cycles 3 to 8.
For Cycles 1 and 2 see higher levels.
This may be used as Cycles 4 to 8.
For Cycles 1, 2 and 3 see higher levels.
This may be used for Cycles 2 to 8.
Cycle 1 is always given as LEVEL 1.
This may be used as Cycles 3 to 8.
For Cycles 1 and 2 see lower levels.
This may be used as Cycles 4 to 8.
For cycles 1, 2 and 3 see lower levels.
This may be used as Cycle 5 to 8.
For Cycles 1, 2, 3 and 4 see lower levels.
This may be used as Cycle 6 to 8.
For Cycles 1, 2, 3, 4 and 5 see lower levels.
Supportive Care Factors
| Factor | Value |
|---|---|
| Antiviral prophylaxis for hepatitis B virus: | Required for anti–HBc positive patients at risk of reactivation |
| Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis may be considered |
| Constipation risk: | laxatives are usually prescribed |
| Emetogenicity: | Variable |
| Gastroprotection: | Gastroprotection may be considered |
| Growth factor support: | Recommended for primary prophylaxis |
| Hydration: | Variable |
| Hypersensitivity / Infusion related reaction risk: | High - routine premedication recommended |
| Mesna uroprotection: | Variable |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Routine antibiotic prophylaxis recommended |
| Tumour lysis syndrome prophylaxis: | Tumour lysis syndrome prophylaxis is recommended |
Hydration: Recommended for Levels 5 and 6; consider for Levels 3 and 4.
Mesna uroprotection: Recommended for Levels 5 and 6; consider for Levels 3 and 4.
Tumour lysis syndrome prophylaxis: Recommended for cycle 1 and consider for subsequent cycles.
References
Roschewski M, Dunleavy K, Abramson JS, et al. Risk-adapted therapy in adults with Burkitt lymphoma: Results of NCI 9177, a multicenter prospective phase II study of DAEPOCH-R [abstract]. Blood 2017;130 (Suppl 1):Abstract 188.
Medicines and Hepatitis B Reactivation Prescriber Update 38(1): 2-3 March 2017 https://medsafe.govt.nz/profs/PUArticles/March2017/MedicinesAndHepatitisB.htm
Rituximab and Hepatitis B Reactivation Prescriber Update 34(3):27 September 2013 https://www.medsafe.govt.nz/profs/PUArticles/Sept2013RituximabHepB.htm
Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.
* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.
s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.